Obeticholic Acid for Prevention in Barrett's Esophagus

Inclusion Criteria: * Known diagnosis of histologically-confirmed BE with either no dysplasia, indefinite for dysplasia, or low-grade dysplasia as defined by the presence of specialized columnar epithelium on histology and \>= 2 cm of involvement on endoscopy * Adequate Barrett's mucosa, which is defined as at least one sample with \>= 50% intestinal metaplasia in biopsies required to satisfy the endpoints of the study * Participants are on proton pump inhibitors (PPI) therapy for \>= 28 days duration * Age \>= of 18 years. Because no dosing or adverse event (AE) data are currently available on the use of OCA in participants \< 18 years of age, children are excluded from this study but will be eligible for future pediatric trials, if applicable * Eastern Cooperative Oncology Group (ECOG) performance status =\< 1 (Karnofsky \>= 70%) * Hemoglobin \>= 10g/dL or hematocrit \>= 30 % * Leukocyte count \>= 3,500/microliter * Platelet count \>= 100,000/microliter * Creatinine clearance (calculated if measured is not available) \>= 30mL/min/1.73m\^2 * Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 1.5 X institutional upper limit of normal (ULN) * Total bilirubin =\< 1.0 X ULN * Alkaline phosphatase =\<1.5 X ULN * Gamma-glutamyl transferase (GGT) =\< 1.5 X ULN * The effects of OCA on the developing human fetus are unknown. For this reason, all men and women of child…