Gastroenterology Group Updates Barrett's Guidelines
First update since 2002 covers screening, surveillance, management, other issues
FRIDAY, March 28 (HealthDay News) -- With esophageal adenocarcinoma rates rising faster than those of melanoma, breast and prostate cancer, the American College of Gastroenterology has published new guidelines for diagnosing and treating Barrett's esophagus, the primary premalignant lesion for this cancer, in the March issue of the American Journal of Gastroenterology.
Kenneth K. Wang, M.D., and Richard E. Sampliner, M.D., writing for the organization's practice parameters committee, recommend against screening for Barrett's in the general population. However, older white males with chronic reflux symptoms are most likely to have the condition.
Patients with documented Barrett's should be considered for surveillance, factoring in issues such as their age and understanding of the surveillance process. Patients with low-grade dysplasia should have follow-up endoscopy within six months, and patients with high-grade dysplasia within flat mucosa need follow-up endoscopy within three months. Management of high-grade dysplasia -- associated with a 30 percent risk of cancer -- may include endoscopic ablation (such as photodynamic therapy), done in conjunction with acid suppression.
"Reflux symptoms can be controlled in most patients with proton pump inhibitor therapy," the authors write. "Twice a day dosing may be necessary in a subgroup of patients. Retrospective studies have shown a decrease in development of dysplasia in patients treated with or prescribed proton pump inhibitors. Studies have suggested that normalization of esophageal acid exposure may decrease markers of proliferation. However, there are currently no data that directly support the use of high-dose antisecretory therapy to delay or prevent the development of esophageal adenocarcinoma."