From the Guidelines
Barrett's esophagus symptoms should be managed with proton pump inhibitors and lifestyle modifications, and patients with a history of severe erosive esophagitis or persistent symptoms despite therapy should undergo upper endoscopy to rule out Barrett's esophagus, as recommended by the American College of Physicians 1.
Diagnosis and Treatment
The diagnosis of Barrett's esophagus is made through endoscopy with biopsy, which reveals intestinal metaplasia where normal squamous epithelium is replaced by columnar epithelium. Treatment focuses on controlling GERD symptoms with proton pump inhibitors like omeprazole (20-40mg daily) or pantoprazole (40mg daily), lifestyle modifications including weight loss, avoiding late meals, elevating the head of the bed, and avoiding trigger foods such as spicy foods, caffeine, and alcohol.
Surveillance and Monitoring
According to the National Institute for Health and Care Excellence (NICE) guidance, individuals with Barrett's oesophagus need to be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies 1. Endoscopic surveillance is recommended to allow for early diagnosis and timely clinical intervention, with surveillance examinations occurring at intervals no more frequently than 3 to 5 years for patients with Barrett's oesophagus and no dysplasia.
Key Points
- Barrett's esophagus is a precursor to esophageal adenocarcinoma, a cancer with poor prognosis
- Patients with a history of severe erosive esophagitis or persistent symptoms despite therapy should undergo upper endoscopy to rule out Barrett's esophagus
- Treatment focuses on controlling GERD symptoms with proton pump inhibitors and lifestyle modifications
- Endoscopic surveillance is recommended for individuals with Barrett's oesophagus to allow for early diagnosis and timely clinical intervention.
From the Research
Symptoms of Barrett's Esophagitis
- Symptoms of Barrett's esophagitis are often related to gastroesophageal reflux disease (GERD) and may include heartburn, regurgitation, and dysphagia 2, 3
- The condition is characterized by chronic esophageal inflammation and metaplastic changes in the esophageal lining, which can increase the risk of esophageal adenocarcinoma 2, 4
Treatment and Management
- Proton pump inhibitors (PPIs) are commonly used to treat Barrett's esophagitis and may help reduce the risk of dysplasia and cancer 2, 4
- Studies have shown that PPI therapy can decrease esophageal exposure to acid, reduce inflammation, and promote healing of the esophageal lining 2, 3
- The choice between continuous and on-demand PPI therapy may depend on individual patient needs and symptoms, with on-demand therapy potentially reducing the total amount of PPI used while achieving similar symptom relief 5
Chemoprevention and Surveillance
- Chemoprevention of dysplasia and cancer in Barrett's esophagus with PPIs appears to be cost-effective, although more studies are needed to confirm this finding 2, 4
- Surveillance of patients with known Barrett's esophagus is important to monitor for dysplasia and cancer, with recommended intervals and methods varying depending on individual risk factors and guidelines 6