Barrett's esophagus secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Hamid Qazi, MD, BSc [2], Amresh Kumar MD [3]
Overview
Effective measures for the secondary prevention of Barrett's esophagus include primary prevention along with endoscopic surveillance every 3-5 years for no dysplasia, 6-12 months for low-grade dysplasia, and every 3 months for high-grade dysplasia in the absence of eradication therapy.
Secondary prevention
Recommendations for secondary prevention of Barrett's esophagus include the primary prevention along with the following:
- Barrett's esophagus is a major risk factor for development of esophageal adenocarcinoma.
- After diagnosis, regular surveillance is needed based on the grade of dysplasia.
- Strong recommendation, low-quality evidence against screening general population with GERD and no risk factors.[1]
Weak recommendation, moderate-quality evidence: Endoscopic surveillance in patients with Barrett's esophagus The following intervals are recommended:
- High-grade dysplasia in the absence of eradication therapy: 3 months.[1]
- Therapy with medications effective to treat GERD symptoms and to heal reflux esophagitis is strongly recommended.
- Use proton pump inhibitors in doses greater than once daily. There is no evidence that higher doses produce a risk reduction in cancer.
- Titrate proton pump inhibitors dose by esophageal pH monitoring.
- Anti-reflux surgery. This is not more effective than medical therpay.
Risks and benefits of long-term PPI therapy should be discussed with the patients.
- Do not use aspirin to prevent esophageal adenocarcinoma in the absence of other indications (e.g. cardiovascular risk factors). Although evidence suggests NSAIDs may decrease the incidence of esophageal cancer, it is not clear if benefits outweight the risks of using this medications.[1]