Barrett's oesophagus and hepatitis A jabs

Our panel of experts answer your clinical questions.

Q: Barrett's oesophagus

A patient presents with Barrett's oesophagus, with a segment length of 3cm. Does he need to take proton pump inhibitors (PPIs) for life, even if he becomes asymptomatic after one year, or can this be taken on an 'as-required' basis for six to eight weeks at a time when he becomes symptomatic?

The short answer is that patients with Barrett's oesophagus should remain on lifelong PPI therapy.

Credit: SPL

Barrett's oesophagus will require lifelong treatment with PPIs

The reason for this is that there is evidence that continuous PPI therapy prevents the progression of dysplasia from mild to severe and therefore reduces the risk of a carcinoma developing. Such treatment may also initiate regression of Barrett's oesophagus.

If the patient is unwilling to remain on lifelong PPIs or his symptoms are not well controlled, consider refferal for a laparoscopic Nissen's fundoplication, as this also reduces the risk of progression of dysplasia and may initiate regression of short-segment Barrett's oesophagus.

Other possible treatments include photodynamic therapy, radiofrequency ablation and submucosal resection, all of which are relatively unproven.

You should consider referring the patient for regular endoscopic surveillance of his Barrett's oesophagus as there is evidence that such a strategy leads to the earlier detection of oesophageal cancers and improved survival.

Mr Dugal Heath, consultant gastroenterologist and laparoscopic surgeon, The London Clinic

Q: Hepatitis A vaccination immunity period

If someone has been given the two hepatitis A injections, as recommended, what immunity does this confer and when would they need a booster? I remember reading somewhere that this may confer immunity for 25 years. Is this correct?

Provided the patient is aged one year or over, is immunocompetent and has received the first and second dose of a licensed hepatitis A monovalent vaccine within the recommended intervals, immunity should be of long-term duration.

The Joint Committee on Vaccination and Immunisation has accepted protection to be of at least 20 years' duration. It is possible that such immunity is lifelong but, for now, we should advise patients that protection will last at least 20 years.

Dr George Kassianos is a GP in Berkshire and spokesman for immunisation at the RCGP and the British Travel Health Association.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GPs who visit care homes face mandatory COVID-19 vaccination, government confirms

GPs who visit care homes face mandatory COVID-19 vaccination, government confirms

All people working in care homes - including GPs visiting patients - will be required...

Just one seat on each NHS integrated care system board will represent GPs

Just one seat on each NHS integrated care system board will represent GPs

Representatives of general practice will hold just one out of 10 seats in total on...

Dorset GP Dr Helena McKeown stands down as BMA chief officer

Dorset GP Dr Helena McKeown stands down as BMA chief officer

BMA chief officer and chair of the association's representative body Dr Helena McKeown...

NHS to set up £30m GP enhanced service for long COVID

NHS to set up £30m GP enhanced service for long COVID

NHS England is set to commission a £30m GP enhanced service for long COVID to boost...

Three quarters of GPs face 'mental distress' after working through pandemic, BMA warns

Three quarters of GPs face 'mental distress' after working through pandemic, BMA warns

Three quarters of GPs are facing 'mental distress' because factors such as heavy...

NHS operating procedure for primary care to remain until UK lifts all COVID-19 restrictions

NHS operating procedure for primary care to remain until UK lifts all COVID-19 restrictions

The NHS standard operating procedure (SOP) for primary care will remain in place...