Barrett's%20esophagus Treatment
Principles of Therapy
Therapeutic Principles of Acid Suppression
- Patients with Barrett’s esophagus have greater esophageal acid exposure than other GERD patients
- Treatment of Barrett’s esophagus aims to diminish the reflux of acid into the esophagus which includes acid suppression to control the signs and symptoms of GERD and maintain a healed mucosa
- Acid suppression therapy is important for healing and squamous regeneration during and after endoscopic therapy
- Aggressive medical treatment with proton pump inhibitors (PPIs) and histamine2-receptor antagonists (H2RAs) to produce near-complete achlorhydria has been recommended
- However, relief of symptoms does not correlate well with complete acid control
- There is no anti-reflux treatment that has been proven to decrease the risk of esophageal adenocarcinoma
Pharmacotherapy
Proton Pump Inhibitors (PPIs)
- Commonly used as 1st-line therapy especially in severe esophagitis
- Given to patients with Barrett’s esophagus with or without GERD symptoms or signs of reflux esophagitis on endoscopy
- If once-daily dosing of PPIs does not control symptoms, increasing the dose to twice daily is appropriate
Histamine2-Receptor Antagonists (H2RAs)
- May be sufficient for patients with short-segment disease and only mild esophagitis