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.

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

 

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