Mastic for Barrett’s Esophagus?

Q I have just come from my doctor who told me that I have Barrett’s esophagus, an erosion of the esophagus from stomach acid, and she wants to put me on esomeprazole, a proton pump inhibitor, for the rest of my life. Would mastic work for this? I have taken it before and it felt better.

JUDITH, Honolulu

A Barrett’s Esophagus (BE) refers to an abnormal change in the cells of the inferior portion of the esophagus, the diagnosis of which requires observing specific macroscopic and microscopic changes. In this disease, the normal squamous epithelium lining of the esophagus is replaced by metaplastic columnar epithelium, a cell type that is typically found in more distal parts of the gastrointestinal system. The medical significance of Barrett’s esophagus is its strong association with esophageal adenocarcinoma, which is a particularly lethal cancer.

It is interesting to point out that ectopic gastric tissue is mostly present in the upper part of the esophagus. Its occurance is frequent to BE. However, it does not have a high colonization of H. pylori, compared to gastric tissue.1 In fact, H. pylori is not typically present in BE. So it would be unlikely that mastic would be of direct benefit. However, mastic can help with dyspepsia (see “Mastic Soothes Bellyaches” in the February 2010 issue), and dyspepsia is fairly common in BE. To date, as far as we know, there have been no H. pylori triple therapy trials with Barrett’s patients. Triple therapy entails the use two antibiotics and a proton pump inhibitor, such as esomeprazole.

References

  1. Yüksel I, Usküdar O, Köklü S, Basar O, Gültuna S, Unverdi S, Oztürk ZA, Sengül D, Arikök AT, Yüksel O, Coban S. Inlet patch: associations with endoscopic findings in the upper gastrointestinal system. Scand J Gastroenterol 2008 Aug;43(8):910-4.
  2. Neumann H, Monkemuller K, Kandulski A, Malfertheiner P. Dyspepsia and IBS symptoms in patients with NERD, ERD and Barrett’s esophagus. Dig Dis 2008;26(3):243-7.

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