Swedish News Blog

Preventing progression of Barrett's esophagus to cancer without surgery

Drew Schembre, MD, FASGE, FACG

Drew Schembre, MD, FASGE, FACG
Medical Director, Swedish Gastroenterology

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:

Barrett’s Esophagus and Esophageal Cancer: The dark side of the acid reflux epidemic

Drew Schembre, MD, FASGE, FACG

Drew Schembre, MD, FASGE, FACG
Medical Director, Swedish Gastroenterology

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

Brian E. Louie, MD

Brian E. Louie, MD
Director of Thoracic Research and Education

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?

There ...

Free Class on Understanding Gastroesophageal Reflux at Swedish/Issaquah on Sept. 26

Swedish News

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.

A new treatment for GERD: The LINX - Reflux Management System

Brian E. Louie, MD

Brian E. Louie, MD
Director of Thoracic Research and Education

Acid reflux, heartburn and indigestion are all forms of gastroesophageal reflux disease or GERD. This common problem afflicts over 20 million people in the United States on a daily basis. As a surgeon who treats patients with some of the most severe symptoms of GERD, I was recently struck by the fact that very little has changed in the treatment of the debilitating problem over the last several decades.

Medications have always been the primary treatment for patients with GERD. TUMS, Rolaids, alka seltzer are easy over the counter remedies that could provide instant but only short-term relief. More potent medications called H2 receptor antagonists (commonly known as Zantac, Pepcid AC) brought about longer lasting relief. These medications were great but many patients experienced a relapse of symptoms.

The newest medications for GERD...

Swedish Advances the Art and Science of Endoscopy; New Center Now Open on 2 SW at First Hill Campus

Swedish News

SEATTLE, March 21, 2012 – In the closing weeks of 2011, Swedish opened the largest, most advanced endoscopy center in the Pacific Northwest on the First Hill campus in Seattle. The 21,600-square-foot, state-of-the-art unit serves as the procedural space for a broad range of minimally invasive cases performed by gastroenterologists, colo-rectal specialists, thoracic and bariatric surgeons and pulmonologists on patients with a broad range of digestive and respiratory diseases.

“This uniquely designed space offers physicians and surgeons from diverse specialties and practices the opportunity to bring their patients the highest level of care in a collaborative, safe and comfortable environment that is easily accessed, spacious and welcoming,” said Swedish Chief Medical Officer John Vassall, M.D.

The new unit was completed just over a year after Swedish Medical Group formed Swedish Gastroenterology – a new, employed gastroenterology, hepatology and endoscopy service that brought together several local gastroenterologists in one Swedish-based group dedicated to providing patients with the highest level specialty and subspecialty care available. Founded by Drs. Drew Schembre and Jack Brandabur, Swedish Gastroenterology was created to bring ...

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