Barrett's esophagus. BARRETT'S ESOPHAGUS OVERVIEWThe esophagus is the tube that connects the mouth with the stomach (figure 1). Barrett's esophagus occurs when the normal cells that line the lower part of the esophagus (called squamous cells) are replaced by a different cell type (called intestinal cells). This process usually occurs as a result of repetitive damage to the inside of the esophagus caused by longstanding acid reflux disease, called gastroesophageal reflux disease (GERD). In people with GERD, the esophagus is repeatedly exposed to excessive amounts of stomach acid. Interestingly, the intestinal cells of Barrett's esophagus are more resistant to acid than squamous cells, suggesting that these cells may develop to protect the esophagus from acid exposure. The problem is that the intestinal cells have a risk of transforming into cancer cells. More detailed information about Barrett's esophagus is available separately. Children can develop Barrett's esophagus, but rarely before the age of five years. Gender — Men are more commonly diagnosed with Barrett's esophagus than women. Ethnic background — Barrett's esophagus is most common in white populations, less common in Hispanic populations, and uncommon in Asian and black populations. Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for. Disposal of unused medicines: How to find a drug collection site near you; Disposal of Unused Medicines: What You Should Know; Codeine and tramadol pain and cough. Having Trouble Sleeping? We've got expert shut-eye solutions to six surprising sleep wreckers that might be keeping you up at night. Inuit describes the various groups of indigenous peoples who live throughout Inuit Nunangat, that is the Inuvialuit Settlement Region of the Northwest Territories and. People who experience anxiety often cannot seem to shake their concerns and worries about everyday events, even though they may know that their anxiety is out of. View the latest health news and explore articles on fitness, diet, nutrition, parenting, relationships, medicine, diseases and healthy living at CNN Health. Lifestyle — Smokers are more commonly diagnosed with Barrett's esophagus than nonsmokers. BARRETT'S ESOPHAGUS SYMPTOMSBarrett's esophagus itself produces no symptoms. Instead, most people seek help because of symptoms of GERD, including heartburn, regurgitation of stomach contents, and, less commonly, difficulty swallowing. BARRETT'S ESOPHAGUS DIAGNOSISA healthcare provider may suspect Barrett's esophagus based upon a person's symptoms and the risk factors described above. An endoscopy is needed to confirm the abnormal esophageal lining. Upper endoscopy — Upper endoscopy is a test that allows your doctor to see the inside of the esophagus and stomach. Before the test, you are sedated to prevent discomfort. The doctor will insert a thin lighted tube into the esophagus. The tube has a camera, which allows the doctor to see the lining of the esophagus. Normally, the lining should appear pale and glossy; in a person with Barrett's esophagus, the lining appears pink or red and velvety. The doctor will remove a small sample of the lining (a biopsy) during the endoscopy so that it can be examined with a microscope for signs of Barrett's. Individual variations in the anatomy of the esophagus and the area where it meets the stomach can make the diagnosis of Barrett's esophagus difficult in some people. BARRETT'S ESOPHAGUS TREATMENTThe goal of treatment in patients with Barrett's esophagus is to control reflux symptoms. Aggressive reflux treatment may be more effective in preventing cancer than treating only when there are reflux symptoms. Most patients are advised to avoid certain foods and behaviors that increase the risk of reflux. Foods that can worsen reflux include. Carbonated beverages can be a problem for some people. Placing bricks or blocks under the head of the bed (to raise it by about six inches) help to keep acid in the stomach while sleeping. It is not helpful to use additional pillows under the head. Medications — A clinician may prescribe medications that reduce the amount of acid produced by the stomach. A class of medications called proton pump inhibitors is commonly recommended. Five different formulations (some of which are available as a generic) are currently available: omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix); any of these is an acceptable option. Surgery — People who have severe reflux may benefit from surgical procedures to reduce reflux. Surgery is not the best treatment in all situations, so you should discuss this option with your doctor. More information about surgical treatments for reflux is available in a separate topic review. The early changes may progress to advanced precancerous changes, and finally to frank esophageal cancer. If undetected, this cancer can spread and invade surrounding tissues. However, progression to cancer is uncommon for any individual patient; studies that follow patients with Barrett's esophagus reveal that fewer than 0. Furthermore, patients with Barrett's esophagus appear to live approximately as long as people who are free of this condition. Patients often die of other causes before Barrett's esophagus progresses to cancer. BARRETT'S ESOPHAGUS MONITORINGMonitoring for precancerous changes is recommended for most patients with Barrett's esophagus. At this time, monitoring includes periodic endoscopy with tissue biopsy. Experts do not agree about the usefulness of monitoring. The benefits of monitoring depend upon each person's chance of developing esophageal cancer, which may be difficult to determine. Benefits — Reasons to perform endoscopic monitoring include. These changes may indicate that the person has an increased risk of cancer. Early detection may be especially important for younger patients. It is sometimes difficult to correctly identify precancerous changes, especially when there is inflammation (usually caused by the ongoing reflux of acid). Many clinicians increase the dose of acid- suppressing medications in this situation. The precancerous changes must then be graded as . The management of low- grade dysplasia is especially controversial. Some physicians recommend frequent endoscopic surveillance for patients with low- grade dysplasia, while others recommend destroying the abnormal tissue with radiofrequency ablation (see below). A person with high- grade dysplasia has more limited options. The management of this condition is controversial. The optimal treatment depends upon the person's age and health and the patient and physician's preference. The options include removal of the esophagus (esophagectomy) and removing (eg, endoscopic mucosal resection) or destroying (eg, radiofrequency ablation, photodynamic or other ablation therapies) the abnormal tissue using endoscopic techniques. Esophagectomy — In removing the esophagus, esophagectomy removes all of the precancerous tissue and some of the lymph nodes near the esophagus. However, this treatment has higher rates of procedure- related death and long- term complications than the endoscopic treatments for dysplasia. Esophagectomy is not necessary in most patients who have dysplasia in Barrett’s esophagus. In some patients, however, it may not be possible to destroy all of the abnormal tissue by endoscopic treatments, and esophagectomy may be recommended for those patients. Esophagectomy should be performed by an experienced physician in a hospital where the procedure is performed frequently. In one study of 3. Endoscopic mucosal resection — Endoscopic mucosal resection (EMR) involves the removal of a large but thin area of esophageal tissue through an endoscope. EMR provides large tissue specimens that can be examined by the pathologist to determine the character and extent of the abnormality and determine if an adequate amount of tissue was removed. Therefore, it can help to confirm the person's diagnosis and completely treat the abnormality (if the abnormal tissue is removed completely). However, this technique is generally performed only in specialized centers. Generally, EMR is performed if the endoscopist sees an area of nodularity in the Barrett’s esophagus. EMR is commonly followed by ablation of the remaining Barrett’s esophagus, usually with radiofrequency ablation (see below). Radiofrequency ablation — Radiofrequency ablation (RFA) is an endoscopic procedure that uses radiofrequency energy (microwaves) to destroy the Barrett’s cells. In short- term studies, RFA has been shown to prevent high- grade dysplasia from progressing to cancer and to prevent low- grade dysplasia from developing more advanced features. However, there is limited information on the long- term outcome of this approach. In up to 5 percent of patients, the procedure causes a complication, such as narrowing of the esophagus, which may require repeated treatments to open the esophagus. Another concern with RFA is that, in a small minority of patients with high- grade dysplasia (less than 2 percent), there may be cancer in the lymph nodes adjacent to the esophagus. RFA cannot cure cancer in the lymph nodes. In all cases, the patient and family should discuss the risks and benefits of possible treatments with a healthcare provider. Photodynamic therapy — Photodynamic therapy is a treatment that uses chemical agents, known as photosensitizers, to kill certain types of cells (such as Barrett's cells) when the cells are exposed to laser light. Patients are given the photosensitizer medication into a vein and then undergo endoscopy. During the endoscopy, a laser light is used to activate the photosensitizer and destroy the Barrett's tissue. However, there is limited information on the long- term outcome of this approach. Furthermore, photodynamic therapy is expensive and available in only a small number of academic medical centers. In up to 4. 0 percent of patients, the procedure causes a complication, such as narrowing of the esophagus, which may require repeated treatments to open the esophagus. Another concern with photodynamic therapy is that patients with high- grade dysplasia may have areas of invasive cancer that are not treated adequately. Photodynamic therapy has largely been replaced by RFA, which appears to be safer and at least as effective. In all cases, the patient and family should discuss the risks and benefits of possible treatments with a healthcare provider. SUMMARYDespite the uncertainties surrounding the monitoring and treatment of Barrett's esophagus, there is consensus on one matter: The available options should be tailored to the individual patient. The following are general guidelines. This may improve or eliminate symptoms of heartburn, reduce inflammation, help prevent complications, and improve the accuracy of endoscopy results.
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April 2017
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