Page 7 - 03- Barrett Esophagus

therapy: Survey every 3 months for 4, then every 6 months twice, and then every 12 months
(1,2)[C].

ALERT
Adherence to recommended surveillance protocols may improve rates of dysplasia and cancer
detection.
Continue surveillance even if the patient has had endoscopic ablation therapy, antireflux
surgery, or esophagectomy.
DIET
Avoid foods that trigger reflux: caffeine, alcohol, chocolate, peppermint, carbonated drinks,
garlic, onions, spicy foods, fatty foods, citrus, and tomato-based products.

PATIENT EDUCATION
Lifestyle modifications: smoking cessation, weight loss, avoid supine position after meals,
avoid tight-fitting clothes, elevate head of bed
No evidence that treating GERD reverses BE or necessarily prevents esophageal cancer.

PROGNOSIS
Annual incidence of esophageal cancer in patients with BE is estimated 0.12–0.6% per year:
Low-grade dysplasia: may be transient; cancer risk 0.7–0.8% per year (3)
High-grade dysplasia: cancer risk 5–9% per year (2,3)
Promising areas for research include the use of biomarkers for risk stratification,
chemoprevention of neoplastic progression, capsule endoscopy for screening, and the use of
vitamins and antioxidants for prevention and treatment.

COMPLICATIONS
Same as GERD: stricture, bleeding, ulceration

REFERENCES

1. Spechler SJ, Sharma P, Souza RF, et al; for American Gastroenterological Association.
American Gastroenterological Association medical position statement on the management of
Barrett’s esophagus. Gastroenterology. 2011;140(3):1084–1091.
2. Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of
Barrett’s esophagus. Am J Gastroenterol. 2016;111(1):30–50; quiz 51.
3. Qumseya B, Sultan S, Bain P, et al; for Standards of Practice Committee of the American
Society for Gastrointestinal Endoscopy. ASGE Guideline on screening and surveillance of
Barrett’s esophagus. Gastrointest Endosc. 2019;90(3):335.e2–359.e2.
4. Bennett C, Moayyedi P, Corley DA, et al; for BOB CAT Consortium. BOB CAT: a large-
scale review and Delphi consensus for management of Barrett’s esophagus with no dysplasia,
indefinite for, or low-grade dysplasia. Am J Gastroenterol. 2015;110(5):662–682; quiz 683.
5. Singh S, Garg SK, Singh PP, et al. Acid-suppressive medications and risk of oesophageal
adenocarcinoma in patients with Barrett’s oesophagus: a systematic review and meta-analysis.
Gut. 2014;63(8):1229–1237.
6. Wani S, Qumseya B, Sultan S, et al; for Standards of Practice Committee. Endoscopic
eradication therapy for patients with Barrett’s esophagus–associated dysplasia and