Barrett's esophagus

• Gastro esophageal reflux disease / GERD—a digestive problem where there is too much backflow of the stomach’s contents into the esophagus—are more likely to have Barrett’s esophagus than those without GERD symptoms.

• Males
• Older age
• Tobacco use
• Obesity

• Heartburn
• Regurgitation

• Upper GI Endoscopy

Lifestyle changes
• Recommendations may include dieting, exercising to maintain a healthy weight, and avoiding tobacco.
• Patients also should decrease the size of portions at mealtime, avoid eating 3 hours prior to bedtime, elevate the head of the bed 6 inches, lose weight (if overweight), and stop smoking.

Diet
(Note: The diet for patients with Barrett esophagus is the same as that recommended for patients with GERD. Patients should avoid the following)
• Fried or fatty foods
• Chocolate
• Peppermint
• Alcohol
• Coffee
• Carbonated beverages
• Citrus fruits or juices
• Tomato sauce
• Ketchup
• Mustard
• Vinegar
• Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs)

Surgery – Anti-Reflux Surgery – Fundopligation (preferably by Laparoscopy)
• During fundopligation surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus so that the lower portion of the esophagus passes through a small tunnel of stomach muscle.
• This surgery strengthens the valve between the esophagus and stomach which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.
• Note: Anti reflux surgery may not eradicate Barrett esophagus, but it certainly is reasonable for appropriate patients who desire surgery for control of GERD symptoms.
• (After anti reflux surgery, most patients with Barrett's enjoy long-lasting relief of reflux symptoms, and nearly all patients consider themselves cured or improved.Mild symptoms recur in one fifth. Importantly, dysplasia regressed in nearly half of the patients in whom it was present before surgery, intestinal metaplasia disappeared in 14% of patients, and high-grade dysplasia and adenocarcinoma were prevented in all. (Ann Surg. 2001 Oct;234(4):532-8; discussion 538-9).).

Endoscopic surveillance
• Endoscopy with biopsy, to look for evidence of Dysplasia (histological markers for increased cancer risk).
• Patients with Barrett esophagus in whom dysplasia is lacking for 2 consecutive yearly endoscopies may be extended to follow-up at 3-year intervals.
• Patients with persistent low-grade dysplasia on repeat endoscopy should undergo surveillance every 6 months for 2 cycles; if no progression of disease is noted, surveillance may be extended to yearly follow-up.

For high-grade dysplasia
• Endoscopic mucosal resection of dysplasia: Procedure where large areas of the oesophagus is removed through an endoscope, preventing progression to cancer in most cases. For early cancers, this is also used for staging the cancer, and may be as effective as surgery for curing very early cancers.
• Radiofrequency ablation: Procedure where the lining of the esophagus is burned off, allowing the normal lining to return.
• Esophagectomy: For esophageal cancer, this surgery removes the esophagus, pulling the stomach up into the chest, and attaching it to the remaining portion of the esophagus.