Barrett's%20esophagus Treatment

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

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