Barrett's esophagus medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
According to the American College of Gastroenterology, the [[patients]] with [[Barrett's esophagus]] are treated with both lifestyle changes and [[medications]]. The lifestyle changes includes avoiding [[dietary]] [[fat]], [[chocolate]], [[caffeine]], [[peppermint]], [[alcohol]], [[tobacco]], avoiding lying down after meals, losing [[weight]], sleeping with the [[head]] of the bed elevated and taking all [[medications]] with plenty of [[water]]. The [[medications]] used to treat [[Barrett's esophagus]] are [[H₂-receptor antagonist|H2-receptor antagonists,]] [[Proton pump inhibitor]] and photosensitizers.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
Patients with BE should receive once-daily PPI therapy. Routine use of twice-daily dosing is not recommended unless necessitated because of poor control of reflux symptoms or esophagitis (strong recommendation, moderate level of evidence).
According to the American College of Gastroenterology, indication for the medical therapy in [[Barrett's esophagus]] [[patients]] are:<ref name="urlDiagnosis and Management of Barrett’s Esophagus | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/diagnosis-and-management-of-barretts-esophagus/ |title=Diagnosis and Management of Barrett’s Esophagus &#124; American College of Gastroenterology |format= |work= |accessdate=}}</ref><ref name="pmid22798736">{{cite journal |vauthors=Amano Y, Kinoshita Y |title=Barrett esophagus: perspectives on its diagnosis and management in asian populations |journal=Gastroenterol Hepatol (N Y) |volume=4 |issue=1 |pages=45–53 |year=2008 |pmid=22798736 |pmc=3394474 |doi= |url=}}</ref>
Aspirin or nonsteroidal anti-inflammatory drugs should not be routinely prescribed to patients with BE as an antineoplastic strategy. Similarly, other putative chemopreventive agents currently lack sufficient evidence and should not be administered routinelyPatients with BE should receive once-daily PPI therapy. Routine use of twice-daily dosing is not recommended unless necessitated because of poor control of reflux symptoms or esophagitis (strong recommendation, moderate level of evidence).
*Patients with BE should receive once-daily [[PPI]] therapy. Routine use of twice-daily dosing is not recommended unless necessitated because of poor control of [[reflux]] [[symptoms]] or [[esophagitis]].
Aspirin or nonsteroidal anti-inflammatory drugs should not be routinely prescribed to patients with BE as an antineoplastic strategy. Similarly, other putative chemopreventive agents currently lack sufficient evidence and should not be administered routinely
*[[Aspirin]] or [[nonsteroidal anti-inflammatory drugs]] should not be routinely prescribed to patients with BE as an antineoplastic strategy. Similarly, other putative chemopreventive agents currently lack sufficient [[evidence]] and should not be administered routinely.
 
[[Treatment]] [[may]] [[be]] [[important]] [[even]] [[if]] [[you]] [[do]] [[not]] [[feel]] [[any]] [[symptoms]].
 
===Lifestyle changes include:===
===Lifestyle changes include:===
* Avoiding [[dietary]] [[fat]], [[chocolate]], [[caffeine]], and [[peppermint]] because they may cause lower [[esophageal]] [[pressure]] and allow [[stomach acid]] to [[flow]] [[backwards]]
* Avoiding [[dietary]] [[fat]], [[chocolate]], [[caffeine]], and [[peppermint]] because they may cause lower [[esophageal]] [[pressure]] and allow [[stomach acid]] to [[flow]] backwards
* Avoiding [[alcohol]] and [[tobacco]]
* Avoiding [[alcohol]] and [[tobacco]]
* Avoiding lying down after meals
* Avoiding lying down after meals
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===Medications to relieve symptoms and control gastroesophageal reflux include:===
===Medications to relieve symptoms and control gastroesophageal reflux include:===
*[[H₂-receptor antagonist|H2-receptor antagonists]]:
**These are competitive blockers of [[histamine]] at [[H2]] [[receptor]] blockers, it inhibits [[acid]] [[secretion]] from [[gastric]] [[parietal cells]]. [[Drugs]] in this categories are:
***[[Ranitidine]]
***[[Famotidine]]
***[[Nizatidine]]
***[[Cimetidine]]
*[[Proton pump inhibitor]]:
**These acts by inhibiting of the [[H+/K+ ATP-ase|H+/K+  adenosine triphosphatase (ATPase)]] [[enzyme]] [[system]] which further inhibits [[gastric acid]] [[secretions]] by [[gastric]] [[parietal cells]]. Various types of [[proton pump inhibitors]] are:
***[[Omeprazole]]
***[[Lansoprazole]]
***[[Esomeprazole]]
***[[Dexlansoprazole]]
***[[Rabeprazole]]
***[[Pantoprazole]]
*[[Photosensitizer|Photosensitizers]]
**Porfimer is a [[photosensitizer]] is used along with photodynamic [[therapy]].
**It acts by absorbing light and transforms into short-lived singlet state, further transformed to a reactive triplet state.
**During the [[triplet]] [[state]], it produces free radical which react with cell membranes and causes damage to the [[mitochondria]], [[endoplasmic reticulum]], and/or plasma membranes.
* [[Antacids]] after meals and at [[bedtime]]
* [[Antacids]] after meals and at [[bedtime]]
* [[Cholinergic]] agents
* [[Histamine]] [[H2]] [[receptor]] blockers
* Promotility agents
* [[Proton pump inhibitors]]: [[Proton pump inhibitor]] [[drugs]] have not yet been proven to prevent [[esophageal]] [[cancer]].
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
===Disease Name===
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2 '''Other Organ system involved 2'''
**: '''Note (1):'''
**: '''Note (2):'''
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 19:03, 21 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2] Amresh Kumar MD [3]

Overview

According to the American College of Gastroenterology, the patients with Barrett's esophagus are treated with both lifestyle changes and medications. The lifestyle changes includes avoiding dietary fat, chocolate, caffeine, peppermint, alcohol, tobacco, avoiding lying down after meals, losing weight, sleeping with the head of the bed elevated and taking all medications with plenty of water. The medications used to treat Barrett's esophagus are H2-receptor antagonists, Proton pump inhibitor and photosensitizers.

Medical Therapy

According to the American College of Gastroenterology, indication for the medical therapy in Barrett's esophagus patients are:[1][2]

  • Patients with BE should receive once-daily PPI therapy. Routine use of twice-daily dosing is not recommended unless necessitated because of poor control of reflux symptoms or esophagitis.
  • Aspirin or nonsteroidal anti-inflammatory drugs should not be routinely prescribed to patients with BE as an antineoplastic strategy. Similarly, other putative chemopreventive agents currently lack sufficient evidence and should not be administered routinely.

Lifestyle changes include:

Medications to relieve symptoms and control gastroesophageal reflux include:

References

  1. ↑ "Diagnosis and Management of Barrett's Esophagus | American College of Gastroenterology".
  2. ↑ Amano Y, Kinoshita Y (2008). "Barrett esophagus: perspectives on its diagnosis and management in asian populations". Gastroenterol Hepatol (N Y). 4 (1): 45–53. PMC 3394474. PMID 22798736.

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