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| Barrett's Esophagus
What is Barrett's Esophagus? Since the cells lining the stomach are protected from contact with acid, their growth into the esophagus may actually be a defense mechanism. It may protect the normal tissue in the esophagus against further damage by GERD. This may explain why the symptoms of GERD seem to lessen in some patients with Barrett's esophagus. Unfortunately, these tissue changes may be a forerunner of cancer of the lower esophagus, known as adenocarcinoma. Cancer of the upper esophagus (squamous cell cancer) is usually related to alcohol and smoking. This type of cancer appears to be decreasing in the population, while the rate of adenocarcinoma is increasing sharply, especially in white males.
Cause and Symptoms Patients with Barrett's usually have symptoms similar to those produced by chronic GERD, such as heartburn and reflux of stomach acid into the mouth. Some Barrett's patients may also suffer from other complications of GERD, such as esophageal peptic ulcers and stricture -- narrowing of the esophagus that comes from scarring. These facts are why it is important for patients with these symptoms to see their physicians regularly. Diagnosis  Treatment Things Patients Can Do
 Medications A certain category of drugs called proton pump inhibitors are the main tool used to markedly reduce stomach acid. These include Prilosec (omeprazole), Prevacid (lansoprazole), AcipHex (rabeprazole), Protonix (pantoprazole) and Nexium (esomeprazole) taken once or twice a day. All of these are equally effective despite some deceptive advertising. Other acid reducing drugs such as Zantac, Pepcid, Axid, and Tagamet are also available. Reglan (metoclopramide) is a drug that can strengthen the LES and so help. Surgery Certain patients with GERD may need surgery to strengthen the LES. This type of surgery is called fundoplication. It is now done by laparoscopy. Laparoscopy is minimally invasive surgery, performed with a tiny incision at the naval and a few needle points in the upper abdomen. Monitoring A diagnosis of Barrett's esophagus requires regular monitoring by a physician. While it is thought that controlling GERD reduces the risk of developing cancer, this has not yet been definitely proven. Therefore, the physician must perform regular endoscopy exams and biopsies to look for dysplasia. Just how often these exams are repeated depends on how far the disease has advanced. If cancer is found, surgery to remove the lower esophagus is usually necessary. Physicians often recommend this procedure when high grade dysplasia is present, so as to prevent the cancer that is likely to occur. The Future There are presently various newer treatments being studied. These involve the destruction of the abnormal cells in the esophagus without the need for major surgery. Summary |
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Heartburn
is a burning sensation felt behind the breastbone and sometimes in the neck and
throat. It is caused by stomach acid refluxing or splashing up into the
esophagus -- the muscular tube that connects the throat to the stomach. At the
lower end of the esophagus where it enters the stomach, there is a strong
muscular ring called the Lower Esophageal Sphincter (LES). The LES should remain
tightly closed, except to allow food and liquid to pass into the stomach.
Heartburn occurs when the LES opens at the wrong time. Almost everyone has this
occasionally, and it is nothing to be concerned about. However, heartburn that
is severe or that occurs frequently over a long period of time can be harmful.
This is known as Gastroesophageal Reflux Disease (GERD). If GERD is untreated,
there is constant acid irritation to the lining of the esophagus, and
complications can occur. About 1 in 10 patients with GERD are found to have a
condition called Barrett's esophagus. It can be serious and may lead to cancer
of the esophagus.
In
time, the Barrett's cells may develop abnormal changes known as dysplasia. Over
a period of perhaps two to five years, the dysplasia may then progress to low
grade, then to high grade dysplasia, and finally to cancer. Fortunately, this
happens only in about 1-5% of patients with Barrett's esophagus.
