GI Conditions
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      2. GI Conditions

      Barrett’s Esophagus

      Condition: Barrett’s Esophagus

      Brief Overview: Barrett’s Esophagus is a condition in which the normal lining of the esophagus is replaced with tissue similar to the lining of the intestines. It is a complication of chronic gastroesophageal reflux disease (GERD) and increases the risk of developing esophageal adenocarcinoma, a rare but serious cancer.

      Prevalence: The prevalence of Barrett’s esophagus in the US is estimated to be ~5.6% of adults, according to UpToDate.

      Etiology: According to UpToDate, “Barrett's esophagus results from chronic reflux esophagitis caused by the gastroesophageal reflux of acid and other noxious substances.”

      Risk Factors:

      • Male
      • Age (average age of dx is 55yo)
      • GERD
      • Obesity
      • Family history
      • Smoking
      • White ethnicity

      Commonly Associated Conditions:

      • GERD
      • Hiatal hernia
      • Esophagitis

      Common Medications:

      • PPI – omeprazole, pantoprazole

      Dosing of Common Medications:

      • Proton Pump Inhibitors (PPIs) — mainstay of therapy
        • Omeprazole (Prilosec) – 20–40 mg once daily, 30 min before breakfast
        • Esomeprazole (Nexium) – 20–40 mg once daily 1 hour before breakfast
        • Lansoprazole (Prevacid) – 15–30 mg once daily before breakfast
        • Pantoprazole (Protonix) – 40 mg once daily before breakfast
        • Rabeprazole (Aciphex) – 20 mg once daily before breakfast
        • Dexlansoprazole (Dexilant) – 30–60 mg once daily
        • Severe or uncontrolled symptoms: may be prescribed twice daily dosing (e.g., omeprazole 20 mg BID).
      • H2 Receptor Blockers (Adjunct or step-down therapy)
        • Famotidine (Pepcid) – 20 mg twice daily
        • Cimetidine (Tagamet) – 1600mg/day divided BID-QID x 12 weeks, taken with food
      • Antacids (Symptom relief, not healing)
        • Calcium carbonate (Tums, Rolaids) – 500–1000 mg orally as needed, up to several times daily
        • Calcium carbonate/magnesium hydroxide/simethicone (Mylanta)
          • Common dose: 10–20 mL orally PRN; Max 60mL/24h up to 2wk
        • Other Therapies (less common, used if motility issues)
          • Metoclopramide (Reglan) – 5-15mg mg up to 4 times daily before meals and at bedtime (⚠️Caution: Black Box Warning - long-term use limited due to risk of tardive dyskinesia, especially in elderly females).
        • ⚠️ Note for coordinators/patients:
          • **Please do not advise the patient to take any medications, even OTC. This is just a guide for your reference if the patient reports they are taking/have been prescribed any of these medications.**
          • PPIs are usually taken 30–60 minutes before breakfast. 
          • Medication adjustments (dose, timing, duration) should always be guided by the patient’s healthcare provider.
          • Regular endoscopic surveillance is essential in Barrett’s.

      Common Labs, Imaging, and Tests:

      • Upper endoscopy with biopsy

      Common Symptoms:

      • Asymptomatic
      • May have symptoms of underlying GERD: heartburn, regurgitation

      Common Treatments:

      • Medication (see above)
      • Diet changes: avoid acidic foods (citrus, tomatoes), chocolate, coffee, caffeine, peppermint, alcohol, fatty foods
      • Behavior modification: avoid eating meals right before lying down or bedtime, eat smaller more frequent meals, elevate head of bed

      Physical Findings:

      • Typically, normal physical exam
      • This is found on imaging studies

      Potential Complications and Contraindications:

      • Esophageal adenocarcinoma
      • Progression from low-grade to high-grade dysplasia
      • Long-term PPI use may require additional monitoring

      General Health and Lifestyle Guidance:

      • Smoking cessation
      • Make sure to work with your healthcare provider to manage underlying GERD
      • Avoid any GERD-triggering foods or substances
      • Limit alcohol intake
      • Weight loss recommendations may be indicated
      • Sleep positioning (bed elevation)
      • Avoid tight-fitting clothing around the abdomen

      Suggested Questions to Ask Patients:

      • How long have you experienced reflux or heartburn symptoms?
      • Are you consistently taking your PPI or acid reducers?
      • Have you had previous endoscopy or biopsy results discussed with you?
      • Do you have trouble swallowing or unintentional weight loss?
      • Are you aware of your surveillance schedule or next check-up?

      Potential Questions to Ask if Patient Reports A Symptom 

      • How long has this been going on? Or, when did this start? 
      • Is it constant, or does it come and go? 
      • How would you rate the severity? Mild, moderate, or severe? 
      • Can you describe the symptom? 
      • How often does this happen? Multiple times per day, daily, weekly, occasionally, etc.  
      • How long does each episode last? 
      • Is it getting better, worse, or staying the same? 
      • What seems to make it better, worse? 
      • Have you tried anything that helps the symptom? 
      • Have you noticed anything specific that brings the symptom on? 
      • Does it interfere with your daily life, activities? 
      • Have you noticed any other symptoms that happen at the same time? 
      • Have you ever experienced this before in the past? 
      • Any recent changes in medications, lifestyle, diet, etc.? 
      • Have you reported this to your healthcare provider yet?  
        • If the answer is yes – what did your healthcare provider say? 
        • If the answer is no – advise to call to report this to healthcare provider 

      Suggested Talking Points:

      • You may need periodic monitoring for precancerous changes
      • Make sure to report any new, worsening, or persistent symptoms to your healthcare provider

      SMART Goal Examples for Barrett’s Esophagus

      1. “I will take my prescribed PPI (e.g., omeprazole 20 mg) every morning 30 minutes before breakfast for the next 30 days.”
      2. “I will stop eating at least 3 hours before bedtime, 7 days a week, for the next month.”
      3. “I will raise the head of my bed by 6–8 inches within 1 week and sleep with it elevated every night.”
      4. “I will reduce coffee intake from 2 cups to 1 cup per day within 2 weeks.”
      5. “I will avoid alcohol on weekdays for the next 4 weeks.”
      6. “I will keep a food and symptom diary daily for 3 weeks to track reflux triggers.”
      7. “I will replace 3 tomato-based dinners per week with non-acidic alternatives for the next month.”
      8. “I will walk for at least 10-20 minutes after dinner 5 nights a week for the next 4 weeks.”
      9. “I will attend all scheduled follow-up appointments, including my next endoscopy, as recommended.”
      10. “I will lose 1–3 pounds over the next month by eating smaller meals and avoiding late-night snacking.”

      Common Trigger Foods for Barrett’s Esophagus

      (Most overlap with GERD triggers, since Barrett’s arises from chronic reflux)

      • Coffee (regular & decaf, acidic and relaxing to LES)
      • Tea (especially black tea)
      • Alcohol (beer, wine, spirits)
      • Carbonated beverages (soda, sparkling water)
      • Citrus fruits & juices (orange, grapefruit, lemon, lime)
      • Tomatoes and tomato-based foods (sauce, ketchup, salsa)
      • Onions (especially raw)
      • Garlic (especially raw)
      • Chocolate
      • Peppermint / spearmint
      • Fried and high-fat foods (fried chicken, fast food, fatty meats, cheese, cream)
      • Spicy foods (chili peppers, hot sauce, heavily spiced meals)
      • Large meals (not a specific food, but a common trigger)

      ⚠️ Note: Triggers vary — keeping a diary helps patients identify their specific foods.

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.