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Guidelines for the Diagnosis and Management of Barrett’s Esophagus

by Dr. Christopher Cutler

In 2015, the American College of Gastroenterology published clinical guidelines for the diagnosis and management of Barrett’s esophagus (BE). The following is a summary of this guideline which the physicians at Granite Peaks Gastroenterology would like to share with you:

  • —Screening of the general population for BE is not recommended.
  • —Screening for BE may be considered in men with chronic (>5 years) and/or frequent (weekly or more) symptoms of gastroesophageal reflux (heartburn or acid regurgitation) and two or more risk factors for BE. These risk factors include: age >50 years, Caucasian race, central obesity, current or past history of smoking, and a confirmed family history of BE or esophageal cancer (in a first degree relative).
  • —Screening for BE in females is not recommended. However, individualized screening could be considered in a woman with multiple risk factors for BE including: age>50, Caucasian race, chronic and/or frequent reflux symptoms, central obesity, current or past history of smoking, and a confirmed family history of BE or esophageal cancer (in a first degree relative).
  • —If the initial endoscopy is negative for BE, repeating an endoscopy to look for BE is not recommended. If the endoscopy reveals significant esophagitis, a repeat endoscopy after PPI (Prilosec) therapy for 8-12 weeks is recommended to ensure healing of esophagitis and exclude the presence of underlying BE.
  • —For BE patients without dysplasia (pre-cancerous cells), endoscopic surveillance should be performed every 3-5 years.
  • —For BE patients with dysplasia of any grade, the biopsies should be read by two pathologists, at least one of whom has expertise in GI pathology.
  • —For patients whose biopsies are indefinite for dysplasia, a repeat endoscopy after 3-6 months of optimized PPI therapy should be performed. If this endoscopy confirms the diagnosis of indefinite for dysplasia, a surveillance interval of 12 months is recommended.
  • —For patients with BE and confirmed low-grade dysplasia, endoscopic therapy (radiofrequency ablation) is considered the preferred treatment, although endoscopic surveillance every 12 months is an acceptable alternative.

—Patients with BE and confirmed high-grade dysplasia should be managed with endoscopic therapy (radiofrequency ablation +/- endoscopic mucosal resection).

—Endoscopic ablative therapies should not be routinely applied to patients with nondysplastic BE because of their low risk of progression to esophageal cancer.

—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.

—Anti-reflux surgery should not be pursued in patient with BE to prevent cancer. However this surgery should be considered in those with incomplete control of reflux symptoms on optimized medical therapy.

—Endoscopic surveillance following elimination of BE for patients with low-grade dysplasia is recommended every 6 months for the first year, and annually thereafter.

—Endoscopic surveillance following elimination of BE for patients with high-grade dysplasia or intramucosal carcinoma is recommended every 3 months for the first year, every 6 months for the second year, and annually thereafter.

If you have any questions about Barrett’s esophagus or your reflux symptoms, please contact your physician at Granite Peaks Gastroenterology.