Yes, there are several promising new treatments for Barrett’s esophagus that focus on less invasive techniques and preventing cancer progression.
- Endoscopic Eradication Therapy. This involves removing or destroying damaged cells using techniques like radiofrequency ablation without major surgery.
- Cryotherapy advancements. New methods use extreme cold to freeze and destroy abnormal tissue, offering an alternative for patients who cannot undergo heat-based treatments.
- Acid suppression monitoring. Enhanced medication protocols and surgical interventions help control the underlying acid reflux that causes the condition.
Gastroesophageal reflux disease (GERD) is the primary risk factor for developing Barrett’s esophagus, a condition where the lining of the esophagus changes to tissue that resembles the lining of the intestine. For years, patients with this condition faced limited options — mostly watchful waiting or invasive surgeries if cancer developed. However, the medical landscape is shifting rapidly.
This article explores the latest treatments for Barrett’s esophagus, explaining how they work and who they might help.
What Is Barrett’s Esophagus and Why Treat It?
Barrett’s esophagus occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach. Over time, this acid exposure damages the esophageal lining. In an attempt to protect itself, the body replaces the normal esophageal cells with tougher, intestine-like cells.
While this tissue change itself does not cause symptoms, it increases the risk of developing esophageal adenocarcinoma, a serious type of cancer. The goal of any treatment for Barrett’s esophagus is to prevent this progression.
Traditionally, doctors managed this condition by controlling acid reflux with medications like proton pump inhibitors (Prilosec, Nexium) and performing regular endoscopies to check for cancer. Today, we can do more than just watch and wait. We can actively treat the abnormal tissue.
Endoscopic Mucosal Resection (EMR)
One of the most effective treatments for removing abnormal tissue is endoscopic mucosal resection (EMR). This procedure allows gastroenterologists to remove precancerous lesions or early-stage cancer from the esophagus lining.
During EMR, the doctor passes a thin, flexible tube called an endoscope down the throat. They inject a solution under the abnormal tissue to lift it away from the deeper layers of the esophagus.
Once lifted, the doctor shaves off the abnormal tissue. This tissue is then sent to a laboratory for analysis. This step is crucial because it tells the doctor exactly how advanced the cellular changes are.
A major benefit of EMR is that it preserves the esophagus. In the past, patients often required an esophagectomy — the surgical removal of part of the esophagus. EMR is much less invasive and has a faster recovery time.
Radiofrequency Ablation (RFA)
Radiofrequency ablation (RFA) has become a standard of care for many patients with Barrett’s esophagus. This technique uses heat energy to destroy the abnormal cells while leaving the healthy tissue underneath intact.
The procedure involves inserting a device attached to an endoscope into the esophagus. This device delivers controlled bursts of heat energy directly to the Barrett’s tissue. The heat kills the thin layer of abnormal cells.
After the procedure, normal, healthy esophageal cells usually grow back in place of the damaged ones. RFA is highly effective at eliminating high-grade dysplasia, which is the stage of cell change just before cancer.
According to a recent study, RFA successfully eradicated dysplasia in over 90% of patients. This high success rate makes it a preferred option for preventing cancer development.
Cryotherapy: Freezing The Abnormal Cells
Cryotherapy offers a different approach by using extreme cold to destroy the abnormal tissue. This is particularly useful for patients who may not be candidates for RFA or those who have had RFA treatment that was not fully successful.
During cryotherapy, the physician sprays liquid nitrogen or carbon dioxide onto the lining of the esophagus. This freezes the water inside the cells, causing them to burst and die.
Like RFA, this allows healthy tissue to regenerate. Recent advancements have made cryotherapy more precise. A newer balloon-based system allows the cold energy to be applied more evenly across a larger area of the esophagus.
Managing Gastroesophageal Reflux Disease (GERD)
Treating the abnormal tissue is only half the battle. You must also stop the acid that caused the damage in the first place. Without controlling gastroesophageal reflux disease, the Barrett’s tissue could return even after successful ablation.
Medications remain the first line of defense. Proton pump inhibitors (PPIs) are powerful drugs that reduce acid production. Common prescription brands include pantoprazole (Protonix) and esomeprazole (Nexium).
However, some patients continue to have reflux despite high doses of medication. For these individuals, surgical options may be necessary to tighten the valve between the stomach and esophagus.
Magnetic sphincter augmentation is a newer surgical option. This involves placing a ring of magnetic beads around the lower esophageal sphincter. The magnets keep the valve closed to stop acid reflux, but separate to allow food to pass through.
Emerging Drug Therapies
Researchers are currently investigating chemoprevention strategies. This involves using medication to lower the risk of cancer developing in patients with Barrett’s esophagus.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have shown promise in some studies. These drugs may help reduce inflammation and interfere with the pathways that lead to cancer cell growth.
The Importance of Surveillance
Even with these new treatments, surveillance remains a cornerstone of care. Surveillance involves undergoing regular upper endoscopy exams with biopsies.
During these exams, the doctor takes small tissue samples to look for dysplasia. Dysplasia refers to the presence of abnormal cells that are not yet cancer but are likely to develop into cancer.
The frequency of these exams depends on the grade of dysplasia found. Patients with no dysplasia may only need an exam every few years. Those with low-grade or high-grade dysplasia require more frequent monitoring and likely intervention.
New technologies are improving surveillance as well. Advanced imaging techniques, such as volumetric laser endomicroscopy, allow doctors to scan the esophagus in greater detail than standard white-light endoscopy. This helps locate subtle abnormalities that might be missed otherwise.
Who Is a Candidate for New Treatments?
Not every patient with Barrett’s esophagus needs ablation or resection immediately. Treatment decisions depend heavily on the risk of cancer progression.
Patients with high-grade dysplasia are almost always recommended for endoscopic eradication therapy (like RFA or EMR). The risk of cancer is too high to ignore.
For patients with low-grade dysplasia, the decision is more complex. Recent guidelines suggest that endoscopic therapy is a reasonable option for these patients to reduce the anxiety of cancer risk and potentially halt disease progression.
Patients with non-dysplastic Barrett’s esophagus (no precancerous changes) are typically managed with acid suppression and surveillance. The risk of cancer in this group is low, so the risks of procedures might outweigh the benefits.
Lifestyle Changes to Support Treatment
Medical treatments work best when supported by healthy lifestyle choices. Because obesity is a major risk factor for gastroesophageal reflux disease and Barrett’s esophagus, weight management is critical.
Patients are advised to avoid foods that trigger reflux, such as spicy foods, caffeine, chocolate, and peppermint. Stopping smoking is also essential, as smoking damages the esophageal lining and increases cancer risk.
Elevating the head of your bed while sleeping can use gravity to keep acid in the stomach. Avoiding meals within three hours of bedtime also reduces nighttime reflux.
Treating Gastroesophageal Reflux Disease in Westlake, OH
If you are struggling with chronic heartburn or have been diagnosed with Barrett’s esophagus, you do not have to face it alone. Early detection and proactive treatment are your best defenses against esophageal cancer.
At North Shore Gastroenterology, our team utilizes the latest technology to diagnose and treat esophageal conditions effectively. We are committed to providing compassionate, expert care tailored to your needs.
Contact us today by calling (440) 808-1212 or using our online form to schedule a consultation. Let us help you protect your esophageal health and improve your quality of life.