Barrett's Esophagus

Statement Describing the Challenge

Barrett’s Esophagus is a condition where a process called intestinal metaplasia takes place. In this process the tissue lining the esophagus is replaced by tissue that is like the lining of the intestine. This condition has no symptoms but is commonly found in people with gastroesophageal reflux disease (GERD). Although people who do not have GERD can have Barrett’s Esophagus, the condition is found 3 to 5 more times in people who also have GERD. Barrett’s is diagnosed through endoscopy and biopsies. Because there are no symptoms it is recommended that adults over 40 who have GERD check for the condition through this process. People with Barrett’s Esophagus have a low risk of developing a rare type of cancer of the esophagus called esophageal adenocarcinoma. Less than 1% of people with Barrett’s develops this cancer and they must have Barrett’s for many years before the cancer develops. Checking for this type of cancer is done through the same process as checking for Barrett’s. Once someone is diagnosed with Barrett’s it is recommended that this person has a regular endoscopy and biopsy to check for precancerous cells called dysplasia. If dysplasia is found and treated, cancer may be prevented. If dysplasia or cancer is found, there are a few endoscopic treatments that can be used as treatments. Photodynamic Therapy (PDT) uses Photofrin, a light sensitizing agent, and a laser to kill precancerous and cancerous cells. Endoscopic Mucosal Resection (EMR) involves lifting the Barrett’s lining and injecting a solution under it or applying suction and then cutting it off. In some cases the two treatments are combined. If the dysplasia or cancer is too severe then it is recommended that part of the esophagus is surgically removed.

Non-Drug Treatments

If precancerous cells or cancer develops: 1.Photodynamic Therapy 2.Endoscopic Mucosal Resection 3.Surgical Removal of most of esophagus

Alternative Medicine Treatments

Chew 250 to 500 mg of deglycyrrhizinated licorice before meals and bedtime to support mucous-membrane healing.

Drug Therapy

Precautionary treatments for people with GERD who have not yet developed Barrett’s Esophagus: Antacids: Alka-Seltzer, Maalox, Mylanta, Rolaids, Riopan, Pepto-Bismol. Anti-secretory drugs: - H2 blockers: cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR),Ranitidine (Zantac 75). - proton pump inhibitors: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphix). Once Barrett’s Esophagus, precancerous, or cancerous cells have developed there are no drug treatments.