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Barrett's Esophagus

About the author

Dr. Minocha (http://www.diagnosishealth.com/minocha.htm) is Professor of Medicine and Director, Division of Digestive Diseases at the University of Mississippi Medical Center in Jackson, MS, and is the author of How to Stop Heartburn; Simple Ways to Heal Heartburn and Acid Reflux.


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Long standing acid reflux or heartburn may damage the wall of esophagus to cause a precancerous condition called Barrett's esophagus. Normally, the wall of esophagus is lined by the cells of the type, "squamous mucosa". Longstanding repeated damage by acid reflux may alter it to the lining of the cells as seen in the stomach or intestine, also known as columnar type. When the alteration or metaplasia of the wall of esophagus is to the intestinal type of lining, it is called Barrett's esophagus.

Is Barrett's genetic?

In a study from the journal Gastroenterology 1997, acid reflux is more common in family members of patients with Barrett's esophagus than in the control group of spouses (46% vs 27%). The researchers also found that GERD was also more common in family members of patients with esophageal cancer than the control (43% vs 23%).

The good news is that whereas there is a genetic component, we as humans can make choices to overcome the role played by genetics.

Barrett's and age

The probability of Barrett's esophagus is much higher in the persons above the age of sixty, primarily due to the cumulative effect of longstanding GERD or acid reflux.

Helicobacter pylori and Barrett's

Evidence suggests that the presence of Helicobacter pylori in the stomach may be protective against acid reflux, Barrett's and cancer of esophagus.

 

 

Barrett's and symptoms

Although heartburn is the commonest symptom of GERD, conversely symptoms may be reduced in elderly with Barrett's. This occurs because the altered lining of the wall Barrett's esophagus may make the subject less sensitized to acid reflux. Thus patients may have lesser or no symptoms despite high degree of acid reflux.

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Endoscopy and GERD

Endoscopy is diagnostic of GERD if erosive esophagitis or Barrett's esophagus is found.

Endoscopy and Barrett's

Barrett's esophagus can not be diagnosed clinically or by x-rays. An endoscopy is required to visualize if the wall of esophagus may be altered to Barrett's. Biopsies are then undertaken to make the final determination by looking at the biopsies under the microscope.

Barrett's and medications

All patients with Barrett's esophagus should be taking the PPI class of medication (Prilosec, Prevacid, Nexium, Protonix, Aciphex) and not just an H2-blocker alone (Zantac, Tagamet, Pepcid, Axid).

Barrett's and dysplasia

Dysplasia refers to how close the cells are to the normal cells. Low-grade dysplasia means although they are abnormal, they are close to normal. High-grade dysplasia implies highly abnormal cells bearing little similarity to normal cells and only one step away from cancer.

 

 

Management of Barrett's esophagus

Patients should be aggressively treated with acid blocking medications of the PPI class. In addition, they require periodic surveillance endoscopies (upper GI scope every 1-3 years), usually every 2 years. Those with low grade dysplasia require more frequent endoscopic surveillance. Those with high grade dysplasia should undergo surgery since on surgery, many of these cases will be found to have co-existing cancer.

Photodynamic therapy (PDT)

As of this writing, PDT is not the mainstream therapy for Barrett's esophagus in order to eliminate its cancerous potential. It is performed through an endoscope and is an investigational tool, which may be employed in lieu of surgery among patients who may otherwise be poor risk for surgery.

                                                        
 

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This is meant to be an informational exercise and NOT a medical consultation. Your doctor is the only one who can best assess your situation and offer you medical advice.

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