For patients with Barrett?s esophagus, GERD therapy with drugs effective in treating symptoms of GERD and treat reflux is clearly indicated, as for patients without Barrett?s esophagus. However, the evidence to support the use of antacids, anti-proton pump in particular, in patients with Barrett?s esophagus only to reduce the risk of progression to dysplasia or cancer is indirect and has not been proven over a long period of testing controlled.To develop the guidelines, a series of 10 key issues were identified by industry experts to encapsulate the most common management problems encountered by physicians. To review the recommendations and notes, see the American Gastroenterological Association Medical Position Statement on the management of Barrett?s esophagus.
Patients with Barrett?s esophagus without abnormal cells: endoscopic eradication therapy is not recommended.
In patients with Barrett?s esophagus, normal cells that line the esophagus are replaced by tissue that is similar to the lining of the intestine. The objective of the eradication of endoscopic treatment is to permanently eliminate all intestinal-type cells in the esophagus. A small number of people with Barrett?s esophagus develop a rare but often fatal form of cancer of the esophagus.
Placebo response rates were numerically lower when the response was determined using ADHD System quotient instead of rating scales and when the response threshold of the most severe was used . Intuitively, one would expect the results of response is low because there should not be the answer to all is used when an inactive placebo. Time of administration of placebo did not affect the number of persons who have response thresholds for scoring Quotient .
Given that cardiovascular deaths are more common than deaths from esophageal cancer in patients with Barrett?s esophagus, screening for cardiovascular risk factors and interventions is warranted.
Other results of the position on the medical management of Barrett?s esophagus are: In patients with multiple risk factors associated with cancers of the esophagus , AGA suggests screening for Barrett?s esophagus. We do not recommend screening the general population with GERD for Barrett?s esophagus.
?The recommendations of the AGA for the treatment of patients with Barrett?s esophagus are based on the best data currently available in the medical literature,? said John M. Inadomi, MD, AGAF, President of the Assembly Committee clinical practice and quality management. ?Determining whether eradication surveillance or endoscopic therapy is the modality of management for patients with Barrett?s esophagus, the AGA strongly supports the concept of shared decision making between doctor and patient. ?
The diagnosis of dysplasia in Barrett?s esophagus should be confirmed by at least one additional pathologist, preferably one who is an expert in esophageal histopathology.
Patients with confirmed low-grade dysplasia : endoscopic eradication therapy is a treatment option and should be discussed with patients as such.
Most patients with high-grade dysplasia can be treated successfully with endoscopic eradication therapy. Esophagectomy in patients with high-grade dysplasia is an alternative, however, evidence suggests that there is less morbidity with ablative therapy.
It is expected that each year, each in 200 patients diagnosed with Barrett?s esophagus develop esophageal cancer, a devastating disease. For advanced esophageal cancer, current treatment options are limited and the chances of survival are low, it is almost universally terminal. However, while patients diagnosed with Barrett?s esophagus, especially those with pre-cancerous cells, they feel a greater level of anxiety and emotion, the real risk of death from esophageal cancer remains low.
The medical position statement was published in Gastroenterology, the official journal of the Institute AGA.
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