Cryotherapy May Improve Acid Reflux Treatment

Acid reflux can lead to Barrett’s esophagus, which increases the chance of developing esophageal cancer.

One of the more serious acid reflux complications is Barrett’s esophagus, which increases a patient’s odds of developing esophageal cancer.

Although the risk of this cancer is relatively low, according to the Mayo Clinic, some experts believe it is one of the faster-growing cancers in the country.

Recently, gastroenterologist Harry Snady, MD, PhD, FACG, told CBS that esophageal cancer has increased significantly over the last 25 years.

In light of this, John Dumot, DO, division chief of gastroenterology at UH Ahuja Medical Center, published a report in Gastroenterology Hepatology on Barrett’s esophagus and one of its new treatments: cryotherapy.

Dr. Dumot explained that all patients with Barrett’s esophagus have gastroesophageal reflux disease (GERD), but not all GERD patients develop Barrett’s esophagus. He suggested that genetics could play a role, but it’s largely unknown why some patients develop it and some don’t.

“Proton pump inhibitor (PPI) treatment has been shown to heal LA class C or D erosive esophagitis with Barrett’s esophagus found in 1 out of 10 patients on follow-up endoscopy,” Dr. Dumot wrote.

Pharmacists could potentially help prevent Barrett’s esophagus for GERD patients by recommending PPI treatment before erosions and reflux damage develop. However, Dr. Dumot noted that damage could appear very early, as there are some cases of Barrett’s esophagus in children.

“Most experts believe that once Barrett’s esophagus is well established, regression with medical therapy alone is highly unlikely,” Dr. Dumot wrote.

One treatment option for patients showing precancerous changes in the esophagus is a procedure in which abnormal cells are frozen using liquid nitrogen. During the procedure, the patient is sedated and a specialized catheter is used to place -320 degree Fahrenheit liquid nitrogen to the esophagus.

Only the top layer of cells are frozen, and this process may need to be done 3 or 4 times to remove all the abnormal cells. As the new cells grow back later, they act as normal esophageal cells.

Dr. Dumot explained that this deep freeze fractures cell membranes and denatures proteins.

“The treatment effect is minimal at first, with the development of a cherry-red appearance and slight ooze of blood in the tissue compared with the tissue’s normal salmon pink appearance,” Dr. Dumot explained. “Within days, the tissue sloughs off and potentially heals with neosquamous epithelium in an acid-suppressed state.”

He estimated cryotherapy’s efficacy to be around 80% for eradicating high-grade dysplasia, 75% for eradicating all dysplasia, and 50% for removing all intestinal metaplasia.

Dr. Dumot said cryotherapy is “very comfortable” for patients, and patients rarely report pain or discomfort. However, he did note that cryotherapy has its technical challenges. For example, during the procedure, visibility can sometimes be obstructed because the endoscope lens can frost over.

Patients can expect a follow-up exam at least every 6 months in the first year, and then yearly after that.

Back in 2013, Dr. Dumot reported that roughly 63 centers offered cryotherapy, but he maintained that the technology was spreading among therapeutic gastroenterologists.

“I foresee cryotherapy becoming a first-line treatment option for patients with Barrett’s esophagus as longer follow-up data become available,” he wrote.