Barrett's esophagus medical therapy

According to the American College of Gastroenterology, the patients with Barrett’s esophagus are treated with both lifestyle changes and medications. The lifestyle changes includes avoiding dietary fat, chocolate, caffeine, peppermint, alcohol, tobacco, avoiding lying down after meals, losing weight, sleeping with the head of the bed elevated and taking all medications with plenty of water. The medications used to treat Barrett’s esophagus are H2-receptor antagonists, Proton pump inhibitor and photosensitizers.

According to the American College of Gastroenterology, indication for the medical therapy in Barrett’s esophagus patients are:^[1][2]

• 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.

• 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

• 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
• Photosensitizers
  • Porfimer is a photosensitizer 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.
• Antacids after meals and at bedtime

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