barrett's%20esophagus
BARRETT'S ESOPHAGUS
Barrett's esophagus is defined as the endoscopic finding in the distal esophagus of proximal-appearing columnar-lined esophagus of at least 1-cm length that is confirmed by histology.
It is considered a premalignant metaplastic condition that usually involves the distal esophagus.
It is postulated that exposure of the esophageal epithelium to acid damages the lining resulting in chronic esophagitis and its healing involves metaplastic process.

Principles of Therapy

  • Patients with Barrett’s have greater esophageal acid exposure than other gastroesophageal reflux disease (GERD) patients
  • Goal of acid suppression in Barrett’s esophagus patients is to control the signs and symptoms of GERD and maintain healed mucosa
    • Treatment of Barrett’s esophagus aims to diminish the reflux of acid into the esophagus
  • There is no anti-reflux treatment that has been proven to decrease the risk of esophageal adenocarcinoma
  • Aggressive medical treatment with proton pump inhibitors (PPIs) and histamine2-receptor antagonist (H2RAs) to produce near-complete achlorhydria has been recommended
    • However, relief of symptoms does not correlate well with complete acid control

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

 

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 07 Aug 2018
A home-based, self-applied wearable electrocardiogram (ECG) patch facilitates diagnosis of atrial fibrillation (AF) among high-risk individuals, according to the mSToPS* trial.
Roshini Claire Anthony, 3 days ago

A genotype-guided approach to warfarin dosing may result in fewer dose adjustments in Asian patients, according to a study from Singapore.

6 days ago

Fungal microbiome, also called the mycobiome, appears to be highly variable in patients with well-characterized fungal diseases, a recent study has shown. Moreover, severe asthmatics have the highest fungal loads, along with those receiving steroid and antifungal therapy.

Tristan Manalac, 4 days ago
The risk of complicated appendicitis is lower in children with IgE-mediated allergy, according to a recent study.