Barrett's esophagus medical therapy

Barrett's Esophagus Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Barrett's Esophagus from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Endoscopic Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Barrett's esophagus medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Barrett's esophagus medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Barrett's esophagus medical therapy
CDC on Barrett's esophagus medical therapy
Barrett's esophagus medical therapy in the news
Blogs on Barrett's esophagus medical therapy
Directions to Hospitals TreatingBarrett's esophagus
Risk calculators and risk factors for Barrett's esophagus medical therapy

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

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

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

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

• 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.

Treatment may be important even if you do not feel any symptoms.

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:
  • 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+ -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
• Antacids after meals and at bedtime
• Cholinergic agents
• Photosensitizers:
  • Porfimer, a photosensitizer which 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.