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

 

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