SEATTLE, Feb. 25, 2013 - KOMONews.com posted an article today about a newly FDA-approved surgical procedure for acid reflux or gastroesophageal reflux disease (GERD) called LINX that Swedish is now offering to patients.
Many people wonder what the treatment for Barrett's Esophagus (BE) is. Treatment for BE without dysplasia consists primarily of controlling esophageal acid exposure, usually with once a day proton pump inhibitor (PPI) medications like omeprazole (Prilosec®). Occasionally, twice a day dosing or even anti-reflux surgery may be necessary to completely control acid reflux. Unfortunately, suppressing acid does not usually cause the Barrett’s tissue to regress or even prevent it from progressing to cancer.
If dysplasia is found on any biopsies, treatment recommendations change:
- Low-grade dysplasia: Close surveillance with endoscopy every 6-12 months or ablation.
- High-grade dysplasia: Endoscopic therapy to destroy Barrett’s tissue or surgery.
- Early cancer: Endoscopic removal of focal cancer followed by tissue destruction or surgery
Experiments performed 20 years ago showed that in most people, once the Barrett’s tissue has been removed or destroyed, normal squamous tissue tends to regrow in the area as long as acid reflux is suppressed.
Endoscopic tissue destruction can be performed many ways:
Heartburn (which was once considered an annoying result of over-eating) has matured into a full-blown medical condition better known as gastro-esophageal reflux or GERD.
GERD, or the sensation of acid or other gastric fluids washing up into the chest or mouth, affects as many as 1 in 5 adults in the US on a monthly basis with up to 6% experiencing symptoms 2 or more times per week. Estimates suggest that about 5% of those who suffer from reflux will develop a potentially pre-malignant condition called Barrett’s esophagus (BE). Named after the British thoracic surgeon who erroneously suggested the condition resulted from a congenitally short esophagus, BE is characterized by “specialized intestinal lining” replacing normal squamous epithelium (ie, wet skin, like the lining of the mouth) in the lower esophagus in response to long-term, repetitive exposure to stomach acid.
While this may seem like a protective adaptation—Barrett’s tissue will not ulcerate and develop scarring the way squamous tissue does—it is inherently unstable and can progress to cancer. The risk for developing adenocarcinoma of the esophagus for people with BE is more than 30 times greater than for people without it.
Luckily, the absolute risk of progression from BE to cancer is relatively low. BE progresses to esophageal cancer at the rate of around 0.2% per year. Further, cancer doesn’t usually develop suddenly. Instead, it progresses through a series of stages termed “dysplasia” meaning bad or unfavorable changes that can be identified on biopsies collected at endoscopy. These changes progress from...
Dysphagia - what it is, what can be done, and why you should speak with your provider if you have trouble swallowing
Dysphagia. This is the technical medical term for difficulty swallowing which is a common complaint. Most people have experienced this sensation in their lives. It can occur when you’re eating something doughy like a bagel or French bread and then take few extra bites before swallowing. If you immediately swallow several times in a row you may get the sensation that the food is slowly passing toward your stomach. Your mouth may salivate; you might get a pressure sensation behind your breastbone; you might experience some pain, burning or discomfort. And, then you will feel instant relief the second the food you swallowed passes from the esophagus into the stomach. This is dysphagia.
For most people, this experience occurs very occasionally and usually when we are trying to eat too much, too quickly.
However, for some patients this symptom may occur more frequently such as daily and sometimes as often as every bite of food. It may also occur with solid food alone or with both solids and liquids. Most people will hope that the symptom will resolve by itself. Over time, they will often change the way they eat to avoid the symptom. They will eat slowly and chew their food till it resembles a paste, or they will use water to make things runny which then allows the food to pass.
What is interesting is that patients are reluctant to see or discuss this symptom with their physicians. In the last few months, I have seen patients who have had the symptom of dysphagia anywhere from 1 year to 40 years before they believed it was important enough to seek medical advice. The simple truth is that dysphagia that happens regularly or requires changes in the way you eat should be reported to a physician to determine the cause of the trouble.
What causes dysphagia?
It is that time of the year when we get together with family and friends at Thanksgiving to eat heaping platefulls of turkey with greasy gravy, green bean casserole and rich pumpkin pie with whipped cream. How about seconds! This can be a difficult scenario for someone with gastroesophageal reflux disease (GERD). People with GERD may be bothered with very troublesome symptoms after ingesting large amounts of rich food.
What is GERD?
Gastroesophageal reflux disease or GERD, as it is commonly called, is a condition where you are bothered by burning chest pain behind their breast bone. This commonly occurs after meals or during the night. You also may experience regurgitation of gastric contents up into the throat, causing coughing and difficulty breathing. It may be common for many people who usually do not have GERD problems to have some GERD symptoms following a large Thanksgiving meal. Other people, however, may have these symptoms on a much more frequent basis.
What causes GERD?
With the swallowing process, food ...
LINX has arrived at Swedish! After several months of preparation, we will be implanting the first 3 LINX devices on September 21, 2012. For our 3 adventurous patients, we are excited to see them have their GERD controlled with the LINX and also hope that it meets their expectations.
To learn more about this procedure and others options for managing GERD, you may wish to come and hear my partners Dr. Ralph Aye and Dr. Alex Farivar talk at Swedish Issaquah on September 26th, 2012. For more information and to register for the 9/26 GERD class, click here.
Update on 9/23: I am happy to report that our patients who have received the LINX device are all doing well.
ISSAQUAH, WASH., Sept. 13, 2012 – On Wednesday, Sept. 26 from 6-7:30 p.m. at Swedish/Issaquah (751 NE Blakely Drive, Issaquah) a free community health education program will be given by two experts in esophageal conditions. The 90-minute class will examine causes of heartburn and gastroesophageal reflux disease (GERD), as well as offer practical steps for personal management and treatment.