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Proton Pump Inhibitors for Barrett’s Esophagus - An Overview

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Proton pump inhibitors are the best therapy provided for Barrett’s esophagus. Read the article below to know more.

Medically reviewed by

Dr. Ghulam Fareed

Published At January 11, 2023
Reviewed AtJuly 17, 2023

What Is Barrett's Esophagus?

Barrett's esophagus is a metaplastic condition in which the specialized intestinal metaplasia replaces the squamous cells of the esophageal epithelium. This occurs in about 10 percent of patients who have gastroesophageal reflux diseases (GERD) and also predisposes to dysplasia and adenocarcinoma. Adenocarcinoma is a rapidly increasing cancer than any other cancer. The best treatment provided for this condition is acid suppression by proton pump inhibitors.

What Are the Causes of Barrett's Esophagus?

A long-standing GERD can lead to Barrett's esophagus. The exact cause of the condition is unknown. In some conditions of GERD, individuals do not exhibit any reflux symptoms, known as ‘silent reflux”. The acid reflux may or may not accompany GERD, but this stomach acid and other chemicals present in the stomach wash back into the esophagus, damage the tissue, and trigger endothelial changes in the lining of the causing Barrett's esophagus.

What Are the Signs and Symptoms of Barrett's Esophagus?

In some cases of Barrett's esophagus, the individuals reveal no symptoms. But associated signs and symptoms can be seen, such as acid regurgitation and heartburn. Continuous heartburn that occurs at least twice a week is a major indicator of the condition. Along with heartburn, a burning sensation occurs in the chest with acid regurgitation (vomit sensation in the back of the throat). The other symptoms include:

  • Worsening sleep along with heartburn.

  • Vomiting

  • Blood in stool.

  • Painful and difficult swallowing.

  • Feeling of obstructed food in the esophagus.

  • Constant sore throat.

  • Sour taste in the mouth.

  • Bad breath.

  • Unintentional loss in weight.

What Are the Risk Factors That Are Associated With Barrett's Esophagus?

The risk factors that increase the risk of getting Barrett's esophagus are:

  • Obesity: Fat accumulation in the abdomen increases the risk of getting Barrett's esophagus.

  • White Individuals: White individuals are more prone to Barrett's esophagus.

  • Males: Males get more affected by Barrett's esophagus.

  • Family History: Any family history of esophageal cancer or Barrett's esophagus can increase the risk of getting Barrett's esophagus.

  • History of Past or Current Smoking: Any history of smoking can increase risk of getting Barrett's esophagus.

  • Age: Barrett's esophagus is more common in adults over the age of 50 years, though it can affect people of any age.

  • Continuous Heartburn and Acid Reflux: Prolong heartburn and acid reflux can increase the chance of having Barrett's esophagus.

How Is the Diagnosis Made for Barrett's Esophagus?

Barrett's esophagus is confirmed by the test called “upper endoscopy”. This test is done by inserting a small tube with a lighted head that passes through the throat into the esophagus, which helps in imaging the change in the lining of the esophagus. The appearance of the esophagus reveals the diagnosis of Barrett's esophagus. Other tests include a tissue biopsy, a tissue sample taken from the esophagus, and observation done under the microscope.

What Is the Treatment Provided for Barrett's Esophagus?

Barrett's esophagus depends largely on the presenting symptoms and dysplasia that is depicted in biopsies. There are many treatments provided for Barrett's esophagus:

  • Cryotherapy: Liquid nitrogen is used to freeze diseased parts of the esophagus, which sheds the lining of the esophagus. The process is the same as ‘freezing off’ a wart.

  • Radiofrequency Ablation: Common procedure that burns off tissue using radio waves that generate heat.

  • Endoscopic Mucosal Resection: An endoscope is used to remove precancerous spots which lie on the esophageal lining.

  • Surgery: Esophagectomy, a surgery to remove all or part of the esophagus.

What Are the Specifications of Proton Pump Inhibitors for Barrett's Esophagus?

Proton pump inhibitors play the main role in the treatment of patients with Barrett's esophagus:

  • Control of Reflux Symptoms: Individuals with Barrett's esophagus reveal symptoms like acid regurgitation, heartburn, dysphagia, and chest pain. Proton pump inhibitors provide faster and more huge relief towards heartburn than H2 receptor antagonists. Proton pump inhibitors provide overall symptom relief.

  • Healing of Coexistent Esophagitis: The healing of existing esophagitis plays a key role in the treatment of Barrett's esophagus. Eliminating the erosive abraded esophagitis so that the erythema of the esophagus permits better delineation of metaplastic epithelium and recognition of dysplasia. Healing of esophagitis is best achieved by proton pump inhibitors, around 84 percent.

  • Prevention of Recurrence of Esophagitis: Individuals with Barrett's esophagus are more likely to have a recurrence of many physiological abnormalities like lower esophageal sphincter tone and impaired esophageal body peristalsis. Proton pump inhibitors prevent relapses in more than 80 percent of cases.

  • Healing of Ulcers: Ulcers are responsible for contributing to anemia and gastrointestinal bleeding in 70 percent of cases. Proton pump inhibitors can help these ulcers in around 80 to 90 percent of cases.

  • Prevention of Stricture Formation: Long-term proton pump inhibitors are necessary to prevent peptic stricture formation; in 70 percent of cases, Barrett's ulcers occur at the squamous-metaplastic junction.

  • Regression of Metaplastic Surface: Proton pump inhibitors, along with ablative endoscopic modality, is used to lower the risk of the length of the tubular esophagus occupied by intestinal metaplasia. Regression of the metaplastic surface is important in managing individuals with Barrett's esophagus.

  • Promotion of the Appearance of Squamous Islands: 90 percent of cases of Barrett's esophagus are treated with a proton pump inhibitor to develop squamous islands. These islands reflect the true regression of metaplastic epithelium.

  • Reduced Duodenal Gastro-esophageal Reflux: The composition of the reflux material is important in Barrett's esophagus. In most cases, the reflux occurs due to acid reflux; though some cases report bile reflux, both reflux tends to go parallel, having a synergistic role. However, aggressive acid suppression therapy along with Omeprazole daily twice increases gastric pH and decreases gastric volume diminishing duodenal gastroesophageal reflux.

  • Management and Prevention of Dysplasia: Intensive anti reflux therapy along with proton pump inhibitors is given to low-grade dysplasia in order to minimize esophageal inflammation. The maintenance of normal epithelial differentiation and proliferated layer is an important goal of chemoprevention. Proton pump inhibitor therapy has an impact on the regression of dysplasia, but few reports prove the impact of the therapy in an induced reduction in cell proliferation and increased cell differentiation on the development of dysplasia.

Conclusion:

Proton pump inhibitors are the main pharmacological agents that help manage Barrett's esophagus as they prevent strictures, control symptoms, and heal ulcers. Bile induces hyperplasia and metaplasia of the esophageal epithelium, and thus, bile salts are the main contributors to esophageal cancer and Barrett's esophagus. Prolonged use of proton pump inhibitors will increase gastric pH that ionizes the bile salt's transportation during GERD (gastroesophageal reflux disease) and thus help in reducing inflammation. Combining the use of NSAIDs (non-steroidal anti-inflammatory drugs) and proton pump inhibitors is a great therapeutic approach to reducing and maintaining the balance of gastric PH below 4.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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