Gastro-Oesophageal Reflux Disease Treatment

Gastroesophageal reflux, also known as acid reflux, occurs when the stomach contents reflux or back up into the oesophagus and or mouth. 

Reflux is a normal process that occurs in healthy infants, children, and adults.  Most episodes are brief and do not cause bothersome symptoms or complications.

In contrast, people with gastroesophageal reflux disease (GORD) experience bothersome symptoms as a result of the reflux. 

Symptoms can include heartburn, regurgitation, vomiting, and difficulty or pain with swallowing. 

The reflux of stomach acid can adversely affect the vocal cords causing hoarseness or even be inhaled into the lungs (called aspiration).

GORD may be caused by relaxation of the lower oesophageal sphincter or valve, allowing stomach content to enter the oeosphagus.  People with a hiatal hernia tend to suffer more severe reflux.

Barrett’s Oesophagus

Well-established risk factors for Barrett’s oesophagus include age older than 50 years, male sex, white race, chronic Gastro-Oesophageal Reflux (GORD), hiatal hernia, elevated body mass index,  and intra-abdominal distribution of body fat.

At the time of diagnosis, the pathologist will assess the biopsy specimen for dysplasia.  Dysplasia is the term used when the cells look abnormal or pre-malignant.  Dysplasia is graded as absent, low-grade or high grade.

Published rates of progression from low-grade dysplasia to either high-grade dysplasia or oesophageal adenocarcinoma (cancer) range from 0.5% to 13.4% per patient per year. 

A recent meta-analysis of multiple historical studies reported an overall risk of progression from high-grade dysplasia to cancer of 4-8% per year.

Endoscopic surveillance should be performed in patients with Barrett’s:

No dysplasia: 3-5 years

Indefinite for dysplasia – 3 months

Low-grade dysplasia: 6-12 months.

High-grade dysplasia in the absence of eradication therapy: 3 months.

Antireflux surgery is not more effective than medical GORD therapy for the prevention of cancer in Barrett’s oesophagus.

Endoscopic eradication therapy with Radio Frequency Ablation (RFA), or Endoscopic Mucosal Resection (EMR) rather than surgery is advised for treatment of patients with confirmed high-grade dysplasia.

RFA therapy for patients with low-grade dysplasia leads to reversion to normal-appearing squamous epithelium in >90% of cases.

Recent studies have shown a higher risk of dysplasia recurrence and malignancy after RFA.

Ongoing surveillance following RFA is therefore recommended.