Barrett's esophagus medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
According to the American College of Gastroenterology, indication for the medical therapy in Barrett's esophagus patients are:<ref name="urlDiagnosis and Management of Barrett’s Esophagus | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/diagnosis-and-management-of-barretts-esophagus/ |title=Diagnosis and Management of Barrett’s Esophagus | American College of Gastroenterology |format= |work= |accessdate=}}</ref><ref name="pmid22798736">{{cite journal |vauthors=Amano Y, Kinoshita Y |title=Barrett esophagus: perspectives on its diagnosis and management in asian populations |journal=Gastroenterol Hepatol (N Y) |volume=4 |issue=1 |pages=45–53 |year=2008 |pmid=22798736 |pmc=3394474 |doi= |url=}}</ref> | According to the American College of Gastroenterology, indication for the medical therapy in [[Barrett's esophagus]] [[patients]] are:<ref name="urlDiagnosis and Management of Barrett’s Esophagus | American College of Gastroenterology">{{cite web |url=https://gi.org/guideline/diagnosis-and-management-of-barretts-esophagus/ |title=Diagnosis and Management of Barrett’s Esophagus | American College of Gastroenterology |format= |work= |accessdate=}}</ref><ref name="pmid22798736">{{cite journal |vauthors=Amano Y, Kinoshita Y |title=Barrett esophagus: perspectives on its diagnosis and management in asian populations |journal=Gastroenterol Hepatol (N Y) |volume=4 |issue=1 |pages=45–53 |year=2008 |pmid=22798736 |pmc=3394474 |doi= |url=}}</ref> | ||
*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. | *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. | *[[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. | ||
===Lifestyle changes include:=== | ===Lifestyle changes include:=== | ||
* Avoiding [[dietary]] [[fat]], [[chocolate]], [[caffeine]], and [[peppermint]] because they may cause lower [[esophageal]] [[pressure]] and allow [[stomach acid]] to [[flow]] | * 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 [[alcohol]] and [[tobacco]] | ||
* Avoiding lying down after meals | * Avoiding lying down after meals | ||
| Line 20: | Line 20: | ||
===Medications to relieve symptoms and control gastroesophageal reflux include:=== | ===Medications to relieve symptoms and control gastroesophageal reflux include:=== | ||
*H2-receptor antagonists: | *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: | **These are competitive blockers of [[histamine]] at [[H2]] [[receptor]] blockers, it inhibits [[acid]] [[secretion]] from [[gastric]] [[parietal cells]]. [[Drugs]] in this categories are: | ||
**Ranitidine | **[[Ranitidine]] | ||
**Famotidine | **[[Famotidine]] | ||
**Nizatidine | **[[Nizatidine]] | ||
**Cimetidine | **[[Cimetidine]] | ||
*[[Proton pump inhibitor]]: | *[[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: | **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 | **[[Omeprazole]] | ||
**Lansoprazole | **[[Lansoprazole]] | ||
**Esomeprazole | **[[Esomeprazole]] | ||
**Dexlansoprazole | **[[Dexlansoprazole]] | ||
**Rabeprazole | **[[Rabeprazole]] | ||
**Pantoprazole | **[[Pantoprazole]] | ||
*Photosensitizers | *Photosensitizers | ||
**Porfimer, a photosensitizer which is used along with photodynamic therapy. | **Porfimer, a [[photosensitizer]] which 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. | **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. | **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]] | * [[Antacids]] after meals and at [[bedtime]] | ||
Revision as of 14:51, 6 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2] Amresh Kumar MD [3]
Overview
Medical Therapy
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.
Lifestyle changes include:
- 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
Medications to relieve symptoms and control gastroesophageal reflux include:
- 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, a photosensitizer which 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
References
- ↑ "Diagnosis and Management of Barrett's Esophagus | American College of Gastroenterology".
- ↑ Amano Y, Kinoshita Y (2008). "Barrett esophagus: perspectives on its diagnosis and management in asian populations". Gastroenterol Hepatol (N Y). 4 (1): 45–53. PMC 3394474. PMID 22798736.