The therapeutic approach to Barrett's esophagus involves treating a patient's symptoms as well as the disease itself. Symptoms of this condition primarily manifest as a result of gastro esophageal reflux disorder (GERD), the most common cause of Barrett's esophagus. Therefore, treatment of GERD is a central focus for relieving symptoms in patients with Barrett's esophagus.
Treatment of GERD
Treatment is based on lifestyle changes as well as medications.
Medications include:
- Antacids: Available over the counter, these agents neutralize gastric acid and relieve the symptoms of heartburn and acid reflux. These drugs should not be taken along with other medications for GERD, due to the possibility of drug-to-drug interaction that may reduce their efficacy.
- Proton-pump inhibitors (PPIs): Patients who fail to respond to over-the-counter medications and lifestyle changes are prescribed PPIs such as omeprazole, pantoprazole, rabeprazole and lansoprazole, all of which reduce the acid produced by the stomach.
- H2-receptor antagonists: These are a variety of drug that may be taken along with or in place of PPIs. These agents include ranitidine, cimetidine and famotidine which all work by blocking the effects of histamine in helping to produce stomach acid.
Lifestyle changes include:
- Weight reduction
- Cessation of smoking
- Eating smaller and more frequent meals
- Avoidance of alcohol, coffee, chocolate, and fatty or spicy foods.
- Eating a healthy, balanced diet and exercising regularly
- Sleeping with head propped up
- Avoidance of tight clothes, especially around the abdomen
Treatment stages for Barrett's Esophagus
During the early stages of the condition when a patient has low-grade dysplasia, acidsuppressing medication is either initiated or increased. Endoscopic examinations are performed every six months to monitor the esophageal tissue for growth or change in cancer status.
During the later stages of dysplasia, treatment options are decided on after taking into consideration factors such as the patient's age, health status and the physician's preference. Surgical options include partial or entire removal of the esophagus (esophagectomy) and the removal of affected mucosa (endoscopic mucosal resection). Affected mucosa may also be destroyed using photodynamic or other ablation therapies.
Surgery for Barrett's esophagus
People with severe reflux may benefit from surgical procedures. Barrett's esophagus leads to precancerous changes in the lower part of the esophagus, which if left untreated, may progress to advanced changes and eventually cancer that may spread and affect surrounding tissues.
There are several surgical options available to patients and these include:
- Esophagectomy: This is used only in cases of high-grade dysplasia or cancer and involves removing either the whole or part of the esophagus to prevent cancerous invasion of surrounding tissue.
- Endoscopic mucosal resection (EMR): During this procedure, a large but thin area of esophageal tissue is removed using an endoscope. Endoscopic tissue samples can then be sent for examination to aid treatment decisions. EMR is the preferred alternative to esophagectomy in patients with high-grade dysplasia or early stage esophageal cancer.
- Photodynamic therapy: This technique employs chemicals called photosensitizers which become toxic to diseased cells on exposure to light.
- Other ablation techniques: Affected tissue may also be ablated using laser beams, electro cauterization or cryotherapy.
