Alginates in relieving sy...

A 46-year-old male with H/o hiatal hernia and gastroesophageal reflux disease (GERD) presented to the hospital to manage long-segment dysplastic Barrett’s oesophagus with high-grade dysplasia (HGD) which had been refractory to treatment with radiofrequency ablation. His last endoscopy revealed residual dysplastic Barrett’s in the lower oesophagus, and biopsies showed persistent HGD. 

Up on presentation, the patient reported that his acid reflux was not well-controlled despite twice daily PPI. He complained of heartburn, nighttime regurgitation, and a nonproductive cough. His past medical history had a small (2 cm) hiatal hernia. He had no history of tobacco, alcohol, or illicit drug use. His medication history included Esomeprazole 40 mg BID and Sucralfate 1 g QID.

Treatment course: Cryotherapy was started. But, it resulted in only mild improvement despite six cryotherapy sessions. His manometry showed ineffective oesophagal motility, while his pH/impedance study revealed significant persistent non-acid reflux. Despite bethanechol therapy, he had only minimal response with multiple side effects. Hence, he was then started on a twice-daily alginate solution (Gaviscon). After initiation of this therapy at eight months, and following his 7th treatment of cryotherapy, endoscopy revealed roughly 75% improvement in his Barrett’s dysplasia. Over one and a half years later, he continues to have complete BE resolution while being maintained on twice-daily PPI and alginate therapy.