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==Overview==
 
Effective measures for the secondary prevention of Barrett's esophagus include primary prevention along with endoscopic surveillance every 3-5 years for no [[dysplasia]], 6-12 months for low-grade [[dysplasia]], and every 3 months for high-grade [[dysplasia]] in the [[absence]] of [[eradication]] [[therapy]].
 
==Secondary prevention==
 
Recommendations for secondary prevention of Barrett's esophagus include the primary prevention along with the following:
 
*[[Barrett's esophagus]] is a major [[risk factor]] for [[development]] of [[esophageal]] [[adenocarcinoma]].
*After [[diagnosis]], regular surveillance is needed based on the grade of [[dysplasia]].
*[[Strong]] [[recommendation]], low-quality [[evidence]] [[against]] [[screening]] [[general]] [[population]] [[with]] [[GERD]] and no [[risk factors]].<ref name="pmid21376940">{{cite journal |author=Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ |title=American Gastroenterological Association medical position statement on the management of Barrett's esophagus |journal=Gastroenterology |volume=140 |issue=3 |pages=1084–91 |year=2011 |month=March |}}</ref>
 
[[Weak]] [[recommendation]], moderate-quality [[evidence]]: [[Endoscopic]] [[surveillance]] in [[patients]] [[with]] [[Barrett's esophagus]]
The [[following]] [[intervals]] are [[recommended]]:
* No [[dysplasia]]: 3–5 [[years]].
* Low-grade [[dysplasia]]: 6–12 [[months]].
 
* High-grade [[dysplasia]] in the [[absence]] of [[eradication]] [[therapy]]: 3 months.<ref name="pmid21376940">{{cite journal |author=Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ |title=American Gastroenterological Association medical position statement on the management of Barrett's esophagus |journal=Gastroenterology |volume=140 |issue=3 |pages=1084–91 |year=2011 |month=March |pmid=21376940 |doi=10.1053/j.gastro.2011.01.030 |url=}}</ref>
* [[Therapy]] with [[medications]] effective to treat [[GERD]] [[symptoms]] and to heal [[reflux esophagitis]] is strongly recommended.
 
* Do not attempt to eliminate [[acid]] exposure of the [[esophagus]]
# Use [[proton pump inhibitors]] in [[doses]] greater than once daily. There is no [[evidence]] that higher [[doses]] produce a risk [[reduction]] in [[cancer]].
# [[Titrate]] [[proton pump inhibitors]] [[dose]] by [[esophageal]] [[pH]] monitoring.
# Anti-reflux [[surgery]]. This is not more effective than [[medical]] therpay.
[[Risks]] and benefits of long-term [[PPI]] [[therapy]] should be discussed with the [[patients]].
 
* Do not use [[aspirin]] to prevent [[esophageal]] [[adenocarcinoma]] in the absence of other indications (e.g. [[cardiovascular]] [[risk factors]]). Although [[evidence]] suggests [[NSAIDs]] may decrease the [[incidence]] of [[esophageal]] [[cancer]], it is not clear if benefits outweight the [[risks]] of using this [[medications]].<ref name="pmid21376940">{{cite journal |author=Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ |title=American Gastroenterological Association medical position statement on the management of Barrett's esophagus |journal=Gastroenterology |volume=140 |issue=3 |pages=1084–91 |year=2011 |pmid=21376940 |doi=10.1053/j.gastro.2011.01.030 |url=}}</ref>


==References==
==References==
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{{Reflist|2}}
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Latest revision as of 16:28, 5 February 2018

Barrett's Esophagus Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Hamid Qazi, MD, BSc [2], Amresh Kumar MD [3]

Overview

Effective measures for the secondary prevention of Barrett's esophagus include primary prevention along with endoscopic surveillance every 3-5 years for no dysplasia, 6-12 months for low-grade dysplasia, and every 3 months for high-grade dysplasia in the absence of eradication therapy.

Secondary prevention

Recommendations for secondary prevention of Barrett's esophagus include the primary prevention along with the following:

Weak recommendation, moderate-quality evidence: Endoscopic surveillance in patients with Barrett's esophagus The following intervals are recommended:

  1. Use proton pump inhibitors in doses greater than once daily. There is no evidence that higher doses produce a risk reduction in cancer.
  2. Titrate proton pump inhibitors dose by esophageal pH monitoring.
  3. Anti-reflux surgery. This is not more effective than medical therpay.

Risks and benefits of long-term PPI therapy should be discussed with the patients.

References

  1. 1.0 1.1 1.2 Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (2011). "American Gastroenterological Association medical position statement on the management of Barrett's esophagus". Gastroenterology. 140 (3): 1084–91. Unknown parameter |month= ignored (help)

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