USMLE Forum Archives - USMLE Step 3 - Barrett’s esophagus
Barrett’s esophagus
zkadhem - 08-18-09 19:22
The guidelines from the American College of Gastroenterology (ACG) recommend an endoscopy every three years for patients with Barrett’s esophagus without dysplasia (Every 1 – 3 years from the American Society of Gastrointestinal Endoscopy - ASGE).
For patients with low-grade dysplasia, surveillance endoscopy should be performed yearly (ACG) or every six months to yearly (ASGE).
For patients with high-grade dysplasia, treatment should be individualized based on their functional status and comorbid conditions. These patients should be offered two alternatives – Intensive surveillance with endoscopy and biopsy every three months, or esophageal resection.
All these patients should be maintained on aggressive antireflux therapy with proton pump inhibitors. This is important prior to biopsy, as active inflammation can appear as cellular atypia/dysplasia and give a false positive result
zkadhem - 08-18-09 19:22
The guidelines from the American College of Gastroenterology (ACG) recommend an endoscopy every three years for patients with Barrett’s esophagus without dysplasia (Every 1 – 3 years from the American Society of Gastrointestinal Endoscopy - ASGE).
For patients with low-grade dysplasia, surveillance endoscopy should be performed yearly (ACG) or every six months to yearly (ASGE).
For patients with high-grade dysplasia, treatment should be individualized based on their functional status and comorbid conditions. These patients should be offered two alternatives – Intensive surveillance with endoscopy and biopsy every three months, or esophageal resection.
All these patients should be maintained on aggressive antireflux therapy with proton pump inhibitors. This is important prior to biopsy, as active inflammation can appear as cellular atypia/dysplasia and give a false positive result
Page 1
#1
Re: Barrett’s esophagus conym5 - 08-18-09 22:09 Barrett’s esophagus without dysplasia ....every 1 – 3 years endoscopy
patients with low-grade dysplasia...every 3-6months endoscopy
high-grade dysplasia....surgical consult
#2
Re: BarrettÂ’s esophagus mtniharika - 10-09-09 11:32 TREATMENT:
Lifestyle changes include:
Avoiding dietary fat, chocolate, caffeine, and peppermint because they may cause lower esophageal pressure and allow stomach acid to flow backwards
Avoiding alcohol and tobacco
Avoiding lying down after meals
Losing weight
Sleeping with the head of the bed elevated
Taking all medications with plenty of water
Medications to relieve symptoms and control gastroesophageal reflux include:
Antacids after meals and at bedtime
Cholinergic agents
Histamine H2 receptor blockers
Promotility agents
Proton pump inhibitors
Surgery to remove a portion of the esophagus may be recommended, if a biopsy shows cell changes that tend to lead to cancer. Such changes are called dysplasia.
Photodynamic therapy (PDT) is an option that may allow you to avoid surgery. PDT involves the use of a special laser device, called an esophageal balloon, along with a drug called Photofrin. Together, the laser balloon and medication lead to destruction of the abnormal cells lining the esophagus, without affecting the normal tissue.
#3
Re: Barrett’s esophagus babbu5508 - 02-23-11 01:49 Barrett's esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia
Page 1