About 10% of people with chronic symptoms of GERD develop Barrett’s oesophagus. The main cause of Barrett’s oesophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis.⁽²⁾Community-based epidemiological and autopsy studies suggest the true prevalence may be up to 20 times greater, as the condition is often asymptomatic until first discovered when the patient presents with oesophageal cancer. CLO is a major risk factor for oesophageal adenocarcinoma, with a lifetime cancer risk of around 10%. The absolute risk is low, however, and more than 95% of patients with CLO die from causes other than oesophageal cancer. The epidemiology and aetiology of CLO are poorly understood. The prevalence is increasing, and it is more common in men (especially white) and those over 50 years of age.
The mean age of patients with Barrett’s oesophagus in Asia ranges from 51.1 to 66.7 years. In terms of gender, studies from Asian countries showed that men are more likely to have Barrett’s oesophagus with a male/female ratio of approximately 1.93–2.09. The prevalence of Barrett’s oesophagus is reportedly as high as 19.9% in Japan and 23.6% in India. While the prevalence of BE in Asia outside Japan and India ranges from 0.06% to 6%).⁽³⁾
Its malignant sequel, oesopha-gogastric junctional adenocar-cinoma, has a mortality rate of over 85%.⁽⁴⁾ The risk of developing oesophageal adenocarcinoma in people who have Barrett’s oesophagus has been estimated to be 6–7 per 1000 person-years.
Diagnosis requires multiple systematic biopsies to maximise the chance of detecting intestinal metaplasia and/or dysplasia. Conventional treatments for Barrett’s oesophagus include lifestyle changes, medications, photodynamic therapy, endoscopic mucosal resection, and surgery.
Barrett’s oesophagus,  is associated with these symptoms: frequent and longstanding heartburn, dysphagia, hematemesis, pain under the sternum where the oesophagus meets the stomach, unintentional weight loss because eating is painful.
Barrett first described the columnar metaplasia in 1950.⁽⁵⁾ An association with gastroesophageal reflux was made in 1953⁽⁶⁾. An association with adenocarcinoma was made in 1975
Case Report
A 38 years old female consulted in August 2014 for the complaints of retrosternal burning, frequent eructations, heaviness in throat and chest since the last one year. There were frequent episodes of dysphagia with choking sensation in throat while eating. She was very anxious as to what will happen to her family if she gets hospitalized. At times, she used to become sad and wept while thinking about her future.
She has been diagnosed as a case of GERD with Barrett’s oesophagitis. (Figure 1)
There is a strong history of recurrent sore throat, infection with fever and diffuse myalgia. Lately, any slight error in the diet led to sore and fever. In the past she had suffered from typhoid in October 2013. There is also a history of recurrent urinary tract infection from January to July 2014 and also recurrent episodes of viral fever with throat infections
Physical Generals
Appetite: Normal
Thirst: Decreased; only two glasses in a day
Stool: Soft, 2-3/day
Urine: Normal
Weight: 58 Kilograms
Gynaecological History: Irregular menstrual cycles; vaginal discharge, slight, whitish, thick, non-irritating, aggravated after menses.
Sleep: Normal
Dreams: No Specific
Likings: Sweets and Salty ²⁺
Thermal Reaction: Ambithermal
Mental Generals:  Fears height. Very cool in temperament, but secretive, very possessive, caring, affectionate, but getting hyper for 4-5 minutes and angry at her children, fastidious³⁺.
Hobbies and interests: Likes listening to light music and dancin
Family History
Mother (alive): Hypertension
Father: Died of cirrhosis of liver
Treatment History: Pantocid 40 mg OD
               
                                                                                                           
Figure 1: Biopsy and endoscopy reports dated July 2014
On 19/8/2014, she complained of dysphagia; the food getting stuck up at the cardiac end of stomach and had difficulty in swallowing. She had to forcibly swallow or had to drink water. She also felt pain in the anterior part of neck. On external examination/palpation the throat was found to be sensitive to touch and internal examination (inspection) revealed mild swelling in throat.
Based on these symptoms, she was prescribed Abies nigra 30, thrice a day for a week.
Case Anaysis
The following rubrics were selected for this case:

1. MIND – DELUSIONS, imaginations – health, he has ruined his
2. MIND – ANXIETY – others, for
3. MIND – SECRETIVE
4. MIND – FEAR – high places, of
5. MIND – PATIENCE
6. MIND – POSSESSIVENESS
7. STOMACH – THIRSTLESS
8. GENERALS – FOOD and DRINKS – sweets – desire
9. GENERALS – FOOD and DRINKS – spices – desire
10. FEMALE GENITALIA/SEX – LEUKORRHEA – white
11. FEMALE GENITALIA/SEX – LEUKORRHEA – thick
12. STOMACH – HEAVINESS – Epigastrium
13. STOMACH – HEAVINESS – eructations amel.
14. STOOL – SOFT
15. FEVER, HEAT – RELAPSING

Repertorization was done using RADAR Version 10.0 ⁽⁷⁾ (Figure 2)
Repertorial Result
Ars alb. 17/11
Sulph. 20/10
Phos. 15/9
Aur met. 11/9
Nat mur. 10/8
Calc. 14/7
Puls. 14/7
Sep. 14/7
Carbo veg 11/7
Lyco 11/7
Chel. 8/7
Management Plan

1. Arsenicum album as a constitutional remedy.
2. Sulphur as intercurrent anti-psoric (miasmatic) and Tuberculinum as intercurrent antitubercular (miasmatic) remedies respectively.
3. Chelidonium as acute organ remedy.
4. Advise to modify her diet and regimen; drink plenty of water, avoidance of late night dinners, spicy and fried food, walking after dinner etc.

Follow Up

Date	Complaints	Prescription	Justification
19/8/14	Food getting stuck up at the cardiac end of stomach, has to forcibly swallow or has to drink water	Abies-n. 30/ TDS X 1 wk.	Symptomatic
24/8/14	40 to 50 % better. But felt heaviness after having gobhi parantha (Indian bread with cauliflower)and Shahi paneer vegetable (creamy cottage cheese dish) in the previous afternoon and  felt better after taking pear and apple.	Puls. 200/ 3 doses stat Sac lac for 2 weeks	Dietary factor; heavy fatty meal
9/9/14	Irritation in throat and burps were better, sadness and anxiety about her state still there, appetite much less, bodyache, tiredness, retrosternal heaviness and heartburn present	Ars. 0/1 BD x 1 wk Chelidonium 30 BD x 1 wk	Repertorization; constitutional. Chelidonium used as an organ remedy, based on the indications and relationship with ars.
15/9/15	Bodyache, tiredness, retrosternal heaviness much better and heartburn once a day. No burning whole week but anxiety still there. Appetite still less.	Ars. 0/1 BD x 1 wk Chel. 30 BD x 1 wk	Same as above Continue to complete its action
23/9/14	Had loose stools on one day; mild rIght sided sore throat	Ars. 0/2 BD x 2 wk Chel. 30 BD x 1 wk	Continued next potency
4/10/14	2nd endoscopy done on 1/10/14: Report findings: ?Barrett’s esophagitis, stomach and duodenum : N; esophagus-one small projection 1 cm long from GE junction; Biopsy taken Report awaited. Acute presentation: Left sided tonsillitis, cold, fever, mild headache with burning in eyes.	Mercurius iodatus ruber 30/ TDS x 2 days followed by Ars alb 0/3 BD x 2 wk Chel. 30 BD x 1 wk	Acute medicine for the acute problem followed by next potency
27/10/14	Biopsy report shows squamous epithelial  hyperplasia with congestion and mild chronic inflammation in cardia, no metaplasia identified	Tub. 1 M, 1 dose  stat x 1 day Ars. 0/3 BD x 1 wk	As she had strong Tubercular base with history of recurrent throat infections and fever since 1 and a half  yrs
3/11/14	Status quo	Ars. 0/4 BD x 2 wk	Next higher potency
17/11/14	Burning in oesophagus > drinking water; with  mild restlessness, and poor appetite	Ars. 0/5 BD x 2 wk Chel. 30 BD x 1 wk	Next higher potency
3/12/14	Developed sore throat with fever and mild bodyaches and sleeplessness	Streptococcin 200/ 3 doses stat/ HS  with Sac lac for 2 wks  and Ars. 0/6 BD x 2 wk	As  acute nosode Next potency of the constitutional
25/12/14	General condition  60 % better	Sac lac with Ars. 0/6 BD for 3 wks	Follow up
17/1/15	Hair fall in bunches.  Desires cold drinks and non vegetarian food	Phos. 1 M x 1 day Ars. 0/7 BD x 4 wks	Next remedy as per repertorization and symptomatic
20/2/15	occasional burning in throat, Heat in soles, pain in both hands and calf muscles < morning > pressure, appearance of some itching eruptions on arms and legs	Sulph. 200/ 3 doses stat x 1 day Ars. 0/8 x 2 wks	As Inter-current symptomatic. next medicine as per repertorization and case moving  to Psoric predominance
3/3/15	Much relief	Sac lac 30 TDS x 10 days	Case improving
12/3/15	Fever with chilliness,  bitter taste , pain in calf muscles, sore throat B/L after taking cold drink and some fried snacks	Hepar sulphuris 200 / 3 doses stat x day Tub. 1 M / 1 dose x 1 day stat advised when asymptomatic	As acute prescription. Anti-miasmatic to boost up immunity and stop recurrence
Reported on 27/3/15	No symptoms, 80% better.	Sac lac continued	Case improved. Under observation

                                                                               
Figure 3: Biopsy and endoscopy reports dated October 2014
Inference
The patient was in a state of anxiety about her condition when she first consulted after gaining information about Barrett’s oesophagus through internet. After taking her case she was reassured and right away the symptomatic remedy was given on the first visit, Abies nigra 30 that helped her and she gained confidence in the system. Thereafter, the case was thoroughly analysed and repertorised. Her constitutional remedy came out to be Arsenicum album that was given in LM potency in varying potencies from 0/1 to 0/8, seeing the gravity of the pathological changes in this case. This remedy was almost continued in the LM potency throughout the case. Chelidonium, a related remedy to Arsenic was selected as there had been a family history of cirrhosis of liver in father, also there had been symptoms in favour of this remedy (Allen’s Encyclopaedia:⁽⁸⁾: ‘Extremely depressed; full of sad thoughts about the present and future, even to weeping; he had no rest of any kind, Eructations, with heartburn and great weariness, Stool softer than usual in the morning; in the afternoon soft stool, with urging’). Tuberculinum 1M was intercurrently used for the strong tubercular base, Phosphorus 1M was given for hair fall in bunches once as second remedy. When the miasmatic state from tubercular changed to psoric state, Sulphur (that came up in repertorization as second remedy) was given for clearing the case. Streptococcin and Hepar sulphuris were given symptomatically for sore throat and fever. Over all in a span of 8 months the patient was markedly improved, about 80%, and is still under observatio
Homoeopathic Perspective
Barrett’s oesophagus is one of complication of chronic GERD that can lead to Adenocarcinoma of oesophagus.
Homoeopathy believes in treating the man in disease and not the disease in man; so a proper understanding of the patient with the suffering is evaluated in terms of anamnesis, his habits, lifestyle, the causa occasionalis and the underlying miasm.
Homeopathic medicines work to relieve the symptoms of gastroesophageal reflux disease by initiating the body’s innate response to a stimulus or to an irritation allowing the body to heal itself. Homeopathy offers a selection of remedies to relieve symptoms of acid reflux and GERD that may act as precursor of Barrett oesophagus or CA oesophagus ⁽¹⁰⁾.
Dietary Management of Barrett Oesophagus
Lifestyle changes like avoiding spicy food, chocolate, fatty foods, avoid caffeine, alcohol and tobacco, maintaining optimum weight, avoid immediately lying down after eating, intake of plenty of fluids, sleeping with the head of bed elevated, consuming lot of green vegetables and fruits.
Conclusion
Homeopathy deals with the patients holistically and considers the linear and non-linear causes as well. In cases where the cause is not known, the homeopathic physician may go into the depth of the case by reviewing the thorough life space of the individual and base his prescription on those unidentifiable (non-linear) causes. As GERD/Barrett’s oesophagus needs a long term monitoring of the case, along with the best selected medicines based on individualized symptoms, he can modify the lifestyle of the patient by advising him/her proper diet and regimen to be followed to check the progression of disease in time primarily and getting cured in the long run. This case is an example of this where the well framed plan of homeopathic treatment brought out the patient of her chronic symptoms beautifully.
References

1. Davidson’s Principles and Practice of Medicine, 21st Edition
2. Stein HJ, Siewert JR (1993). “Barrett’s esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management”. Dysphagia 8 (3): 276–88
3. http://www.medscape.com/viewarticle/740026_2
4. Holmes RS, Vaughan TL (January 2007). “Epidemiology and pathogenesis of esophageal cancer”. Semin Radiat Oncol 17 (1): 2–9
5. Barrett NR (October 1950). “Chronic peptic ulcer of the oesophagus and ‘oesophagitis’”. Br J Surg 38 (150): 175–82
6. Allison PR, Johnstone AS (June 1953). “The oesophagus lined with gastric mucous membrane”. Thorax 8 (2): 87–101
7. RADAR Version 10.0
8. Allen T. F., Encyclopedia of Pure Materia Medica. New Delhi: B Jain Publishers; 2009
9. http://www.drthindhomeopathy.com/diseases/barrett-syndrome-barrett-esophagus
10. http://www.naturalnews.com/028924_GERD_homeopathic.html
11. Boericke W. New Manual of Homoeopathic Materia Medica with Repertory. 3rd Revised and Augumented Ed. New Delhi: B Jain Publishers; 2010

About the Author
Dr Neeraj Gupta, M.D. (Hom.), MA (Psych.), PGDGC, PGDHHM, is Reader NFSG or Associate Professor in Nehru Homoeopathic Medical College, New Delhi in the Department of Organon of Medicine, Chronic Diseases and Psychology since 2002. He is incharge of psychiatry OPD at NHMC; PG guide for psychiatry (Agra University) and organon (Delhi University) for more than 5 years. He has authored several papers in various national and international journals. He has presented scientific papers on autism, anxiety, depression, adolescent mental health, behavioural disorders, plastic leaching etc. in various national and international conferences. He is the panelist speaker of All India Radio and has given public talks on various health related issues on Aakashwani, FM Gold and Indraprastha channel. He has been a resource person of CCH for workshops on Organon and Homoeopathic Medical Technology. He has been the recipient of Life Time Achievement award and Dr D.P. Rastogi award conferred to him by Delhi Homoeopathic Board for recognition of meritorious services rendered by him.