Barrett's esophagus medical therapy: Difference between revisions
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==Overview== | ==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 antagonist|H2-receptor antagonists,]] [[Proton pump inhibitor]] and photosensitizers. | |||
==Medical Therapy== | ==Medical Therapy== | ||
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 | 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> | 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 | 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> | ||
*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]]. | *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. | ||
===Lifestyle changes include:=== | ===Lifestyle changes include:=== | ||
| Line 19: | Line 19: | ||
===Medications to relieve symptoms and control gastroesophageal reflux include:=== | ===Medications to relieve symptoms and control gastroesophageal reflux include:=== | ||
*H2-receptor antagonists: | *[[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: | **These are competitive blockers of [[histamine]] at [[H2]] [[receptor]] blockers, it inhibits [[acid]] [[secretion]] from [[gastric]] [[parietal cells]]. [[Drugs]] in this categories are: | ||
**[[Ranitidine]] | ***[[Ranitidine]] | ||
**[[Famotidine]] | ***[[Famotidine]] | ||
**[[Nizatidine]] | ***[[Nizatidine]] | ||
**[[Cimetidine]] | ***[[Cimetidine]] | ||
*[[Proton pump inhibitor]]: | *[[Proton pump inhibitor]]: | ||
**These acts by inhibiting of the H+/K+ -adenosine triphosphatase (ATPase) [[enzyme]] [[system]] which further inhibits [[gastric acid]] [[secretions]] by [[gastric]] [[parietal cells]]. Various types of [[proton pump inhibitors]] are: | **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]] | ***[[Omeprazole]] | ||
**[[Lansoprazole]] | ***[[Lansoprazole]] | ||
**[[Esomeprazole]] | ***[[Esomeprazole]] | ||
**[[Dexlansoprazole]] | ***[[Dexlansoprazole]] | ||
**[[Rabeprazole]] | ***[[Rabeprazole]] | ||
**[[Pantoprazole]] | ***[[Pantoprazole]] | ||
*Photosensitizers | *[[Photosensitizer|Photosensitizers]] | ||
**Porfimer | **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. | **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. | **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. | ||
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:
- 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 lying down after meals
- Losing weight
- Sleeping with the head of the bed elevated
- Taking all medications with plenty of water
Medications to relieve symptoms and control gastroesophageal reflux include:
- H2-receptor antagonists:
- Proton pump inhibitor:
- These acts by inhibiting of the H+/K+ adenosine triphosphatase (ATPase) enzyme system which further inhibits gastric acid secretions by gastric parietal cells. Various types of proton pump inhibitors are:
- 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
References
- ↑ "Diagnosis and Management of Barrett's Esophagus | American College of Gastroenterology".
- ↑ 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.