Treatment

Treatment for Barrett's esophagus depends on the extent of abnormal cell growth in your esophagus and your overall health.

No dysplasia

Your doctor will likely recommend:

  • Periodic endoscopy to monitor the cells in your esophagus. If your biopsies show no dysplasia, you'll probably have a follow-up endoscopy in one year and then every three years if no changes occur.
  • Treatment for GERD. Medication and lifestyle changes can ease your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option. Treating GERD doesn't treat the underlying Barrett's esophagus and likely won't decrease the risk of esophageal cancer, but can help make it easier to detect dysplasia.

Low-grade dysplasia

If low-grade dysplasia is found, it should be verified by an experienced pathologist. For low-grade dysplasia, your doctor may recommend another endoscopy in six months, with additional follow-up every six to 12 months.

But, given the risk of esophageal cancer, treatment may be recommended if the diagnosis is confirmed. Preferred treatments include:

  • Endoscopic resection, which uses an endoscope to remove damaged cells.
  • Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.

If significant inflammation of the esophagus is present at initial endoscopy, another endoscopy is performed after you've received three to four months of treatment to reduce stomach acid.

High-grade dysplasia

High-grade dysplasia is generally thought to be a precursor to esophageal cancer. For this reason, your doctor may recommend endoscopic resection or radiofrequency ablation. Other options for treatment include:

  • Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells.
  • Photodynamic therapy, which destroys abnormal cells by making them sensitive to light.
  • Surgery in which the damaged part of your esophagus is removed, and the remaining portion is attached to your stomach.

Recurrence of Barrett's esophagus is possible after treatment. Ask your doctor how often you need to come back for follow-up testing. If you have treatment other than surgery to remove abnormal esophageal tissue, your doctor is likely to recommend medication to reduce acid and help your esophagus heal.

July 13, 2017
References
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  2. Spechler SJ, et al. Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis. http://www.uptodate.com/home. Accessed Feb. 17, 2017.
  3. Shaheen NJ, et al. ACG clinical guideline: Diagnosis and management of Barrett's esophagus. American Journal of Gastroenterology. 2016;111:30.
  4. Barrett's Esophagus. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/all-content. Accessed Feb. 19, 2017.
  5. Feldman M, et al. Barrett's esophagus. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Feb. 17, 2017.
  6. Hu Q, et al. Proton pump inhibitors do not reduce the risk of esophageal adenocarcinoma in patients with Barrett's esophagus: A systematic review and meta-analysis. PLoS One. 2017;12:1.
  7. Krishnamoorthi R, et al. Risk of recurrence of Barrett's esophagus after successful endoscopic therapy. Gastrointestinal Endoscopy. 2016;83:1090.
  8. Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Jan. 25, 2017.