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Barrett's Esophagus

Treatment for Barrett's Esophagus

Barrett's Esophagus Patient Testimonial:

 

What is Barrett's esophagus?
Barrett's esophagus treatment overview
Surveillance - early detection of dysplasia and cancer
Treatment for dysplasia or esophageal adenocarcinoma
Schedule an appointment

Barrett's esophagus treatment overview

The treatment for Barrett's esophagus always starts with reducing the amount of acid that refluxes (flows backward) from the stomach into the esophagus. Since it is believed that this exposure plays a key role in causing Barrett's esophagus, these patients are frequently given acid-reducing medications such as proton pump inhibitors or PPIs. It is important to take the medications as prescribed by your doctor, preferably 30 to 60 minutes before a meal, which maximizes their acid-reducing power. Appropriate use of these medications has been shown to decrease the amount of Barrett's tissue in some patients and possibly even help to slow the spread of Barrett's and associated pre-cancerous changes.

Additional treatment approaches, including anti-reflux surgery, have not yet shown a benefit in the treatment for Barrett's esophagus. However, new treatments that can be given during endoscopy show great promise in being able to remove Barrett's tissue without surgery (see Treatment for dysplasia or esophageal adenocarcinoma below).

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Surveillance - early detection of dysplasia and cancer

Periodic endoscopic examinations to look for early warning signs of cancer are generally recommended for people who have Barrett's esophagus. This approach is called surveillance. When people who have Barrett's esophagus develop cancer, an intermediate stage often occurs where abnormal-appearing cells are found in the Barrett's tissue. This condition is called dysplasia and can be seen only when biopsies are viewed using a microscope. When checking for dysplasia, multiple biopsies are taken because it may occur in only a small area of the Barrett's esophagus. Even then, pre-cancerous cells can be missed.

Barrett's biopsies are usually reported with the following readings:

  • "Negative for dysplasia" - This means that there are no unusual changes in the Barrett's tissue.
  • "Indefinite for dysplasia" - This is an intermediate reading between negative and low-grade dysplasia. It simply means that the pathologist is not certain whether changes seen in the tissue are due to dysplasia. For example, poor control of a patient's acid reflux may be responsible for the changes seen, not progression of the Barrett's tissue toward cancer.
  • "Low-grade dysplasia" - Abnormal cells have begun to change in size, shape or organization and may show an increase in their growth rate. The cells are contained within the lining of the esophagus and have not spread to other areas.
  • "High-grade dysplasia" - As with low-grade dysplasia, the abnormal cells reside within the lining of the esophagus. However, the abnormal cells demonstrate more significant abnormalities in how they look and grow.

Overall, the process of change from Barrett's to cancer seems to happen in less than one percent of patients every year. The goal of surveillance is to identify the patients who are on their way to developing invasive cancer, so that their Barrett's esophagus can be treated as soon as possible. The waiting time between endoscopies is different for each patient and depends on many factors, including how advanced the pre-cancerous changes were on prior biopsies (tissue samples taken from the Barrett's area).

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Treatment for dysplasia or esophageal adenocarcinoma

For many years, the only treatment available to patients who had Barrett's esophagus with pre-cancerous dysplasia or had developed an actual cancer was surgery. Called an esophagectomy, this very invasive surgery has a relatively high risk of complications. The procedure usually involves removing most of the esophagus and attaching the stomach to what remains of the esophagus.

New technologies have emerged that allow for non-surgical treatment of Barrett's esophagus with dysplasia, and even some early esophageal cancers. One treatment option, radiofrequency ablation or RFA, delivers energy directly to the Barrett's cells, causing them to die and be replaced by normal cells when the lining of the esophagus regenerates. Another treatment option, cryo-ablation, involves exposing the Barrett's tissue to extremely cold temperatures to kill off the pre-cancerous cells. This technique, which uses super-cold liquid nitrogen or carbon dioxide, is similar to removing a wart in the dermatologist's office. A third treatment option, endoscopic mucosal resection (EMR), uses special equipment mounted on the endoscope to "scoop out" large sections of Barrett's mucosa. While surgery is still the preferred approach to treating invasive esophageal cancer, these endoscopic techniques have become a first-line approach to removing dysplasia and some early-stage cancers.

Because the configuration and appearance of each patient's Barrett's esophagus is different, your gastroenterologist must develop a treatment plan specific to your individual needs. This often includes using at least two of the available treatment options in combination to help ensure that all of the Barrett's tissue is removed. It is important for you and your doctor to discuss the various treatment options and why certain approaches would be better than others.

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Schedule an appointment

We would be glad to meet with you to discuss your Barrett's esophagus and work with you on an individualized Barrett's esophagus treatment plan.

To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].

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Sources:

National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health (NIH) – NIH Publication No. 05-4546, December 2004

Smith, MS, and Lightdale, CJ. Review: Barrett's esophagus and the increasing role of endoluminal therapy. Therapeutic Advances in Gastroenterology. 2008: 1(2): 121-42.

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