Barrett's Esophagus

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Treatment

Barrett's esophagus usually does not require treatment. In some cases, conservative treatment (e.g., dietary and lifestyle changes, medication) can help prevent progression of the disorder.

Patients who have Barrett's esophagus should not smoke, should maintain a healthy weight, and should exercise regularly. Eating smaller meals, waiting 3 or 4 hours after eating to lie down, and avoiding foods that cause heartburn (e.g., foods high in fat [fried foods], coffee, chocolate, onions, garlic, acidic foods [tomatoes, oranges]) may help reduce symptoms of acid reflux.

In patients who experience severe acid reflux, over-the-counter or prescription medications may be used to relieve symptoms. These medications include the following:

• Antacids (e.g., Tums®, Rolaids®, Maalox®, Mylanta®, Pepto-Bismol®)
• H-2 receptor blockers (e.g., Pepcid® AC, Tagamet®)
• Proton pump inhibitors (e.g., Prilosec®, Nexium®, Prevacid®, Aciplex®)

Although these medications can help reduce symptoms of acid reflux, they usually do not improve Barrett's esophagus or lower the risk for developing cancer of the esophagus. Side effects of these drugs include diarrhea, constipation, dry mouth, dizziness, drowsiness, and headache.

Patients who have severe dysplasia are at high risk for developing esophageal cancer. In these patients, surgery to remove all or part of the esophagus (called esophagectomy) may be performed. If esophageal cancer is confirmed through biopsy, esophagectomy also involves removal of nearby lymph nodes and surrounding tissue.

Standard transthoracic esophagectomy is a procedure performed through an incision between the ribs that opens one side of the chest and transhiatal esophagectomy is performed through incisions in the upper abdomen and lower neck. In some cases, a section of the intestine is used to replace the portion of the esophagus that is removed. In other cases, the healthy remaining portion of the esophagus is attached to the stomach (called anastomosis).

Following esophagectomy, most patients remain in the hospital for about two weeks. Pain from the procedure usually can be controlled using prescription pain medications. Complications may be serious and include the following:

• Anastomotic leakage
• Bleeding
• Heart and lung complications (e.g., arrhythmia, heart attack, pneumonia, pleural infusion)
• Infection at the incision site or throughout the body (sepsis)
• Nerve injury

After esophagectomy, most patients can resume normal activities in about 2 months.

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