Barrett's esophagus secondary prevention

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Secondary prevention

Recommendations:

• Therapy with medications effective to treat GERD symptoms and to heal reflux esophagitis is strongly recommended.

• Do not attempt to eliminate acid exposure of the esophagus

1. Use proton pump inhibitors in doses greater than once daily. There is no evidence that higher doses produce a risk reduction in cancer.
2. Titrate proton pump inhibitors dose by esophageal pH monitoring.
3. Antireflux 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.