'heartburn' posts

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...

April is esophageal cancer awareness month and I was stimulated by two patients I saw recently to highlight the association of esophageal cancer with chronic GERD (heartburn, acid reflux) and the over the counter treatments people take for GERD.

Why am I writing about this? To highlight three common issues I hear everyday: