Today’s question addresses one we commonly hear: what’s the best treatment for Barrett’s disease? After ten years of taking PPI GERD medicine, this member’s GERD progressed to Barrett’s esophagus, a pre-cancerous condition. What’s next and how can this example help others on the same path?
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I am a 74 years old male, 5’8”, and 148 lbs. I exercise every day, and I am very disciplined. I follow a diet that is recommended for Laryngopharyngeal Reflux Disease (LPR), Dr. Jamie Koufman’s Dropping Acid: The Reflux Diet Cookbook and Cure. I stop eating 3 to 5 hours before going to bed, and my bed is elevated over 6 inches. I was diagnosed with Laryngopharyngeal Reflux (LPR) two years ago and was put 2 omeprazole, sodium bicarbonate caps, and one 1000 Mcg B12 a day. For the ten years prior I was on Aciphex (PPI) for acid reflux. My otolaryngologist says I now have Barrett’s disease. I asked my otolaryngologist, as well as my internist and gastroenterologist, about weaning off omeprazole as I read about the side effects, but none of them recommended it. What is your opinion?
Thanks for sending us your question and it is an interesting one at that! RefluxMD’s mission is to provide all our members with the necessary information to make an informed decision that is the best one for them. Let’s summarize your situation and outline your alternatives so that you can make that decision.
Your current treatment plan
You have GERD/LPR and have been diagnosed with Barrett’s esophagus. This is a result of your stomach contents surging up into your esophagus due to a damaged lower esophageal sphincter (LES). Over time, the contents of the stomach can damage the lining of the esophagus and lead to a variety of complications, including Barrett’s esophagus, which is a pre-cancerous condition that increases the risk of developing esophageal adenocarcinoma (esophageal cancer).1
Your current treatment plan includes a GERD-friendly diet and lifestyle changes combined with a GERD medicine, very powerful proton pump inhibitors (PPIs), is the most commonly prescribed GERD treatment today. While this approach to Barrett’s esophagus is common, there are many health risks associated with the long-term daily use of this strong GERD medicine. Additionally, PPIs do nothing to stop the reflux that caused the damage to your esophagus – they only reduce your GERD symptoms – and there’s no evidence that they do anything to prevent further progression of your condition.2 We have two articles I think you’d be interested in that shed additional light on this issue: Do proton pump inhibitors prevent esophageal cancer? And Common questions about Barrett’s esophagus.
At this point, your primary concern should be the further progression of your disease, and unfortunately, your current treatment plan does not provide you that protection. As someone with Barrett’s, you have a much higher chance of progressing to adenocarcinoma. Let’s take a look at some additional treatments that you might also consider.
Additional Treatment Options for Barrett’s disease
Acid reflux surgery
Your other alternative is antireflux surgery. Had a top surgeon performed this surgery before you started your Aciphex treatment, you would have had an excellent probability of being symptom-free within a few months and it’s possible your Barrett’s would never have developed.4 Unfortunately, those with GERD rarely seem to have an honest discussion about this alternative. There are several procedures available today, including the new LINX Reflux Management System that many patients should consider and evaluate. I encourage you to discuss this surgical treatment plan with your physicians to determine if they are right for you. However, there does appear to be a bias among gastroenterologists, who most seem to prefer PPI treatment rather than surgery. We explained this in a recent article, Should I have Acid Reflux Surgery? Be sure you glace at the member poll results.
You can also have ablation performed on your Barrett’s based upon the stage of your disease, and many surgeons would recommend this before surgery. The goal of this procedure is to eradicate the damaged cells in your esophagus, halting the progression towards cancer. It’s important to note, however, the RF ablation, unlike surgery, does not affect the symptoms of reflux and doesn’t stop reflux from happening in the future. Although results seem to be positive for any stage, many physicians only recommend ablation for those exhibiting dysphasia.3 This is a fairly simple process that only takes a few months. We had a member share his story about his ablation that you may find interesting. However, after ablation, you will either need to consider either PPI medication or surgery to avoid the potential for any further complications. Again, that should be your decision and made in consultation with your physician.
I then encourage you to discuss all these options with your physicians before you finalize YOUR DECISION. If you feel that your doctor is not meeting these standards, please use our DocMatch tools and we will recommend a GERD expert who does.
I hope this helps!
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4. http://www.medscape.com/viewarticle/540684. Duration of Efficacy of Fundoplication in Patients With GERD. Brant K. Oelschlager, MD