By Dr. Ulin Sargeant
Bethany is a pleasant 48-year-old woman with a medical history of reflux disease for the past 10 years which usually responded well to the reflux medication, Protonix, I was giving her for her symptoms. But, she started coming to me complaining that her symptoms were not going away with the medication anymore. Any food she ate, not just the ones high in fat or acid, was starting to cause her pain under her breastbone when she swallowed which eventually led to her eating less and less which, of course, led to unwanted weight loss.
I checked for H-Pylori in her stool which was positive and treated her with two antibiotics and Protonix. Unfortunately, her symptoms persisted. I sent her to see a specialist about 5 years ago who did an upper endoscopy at the time which only showed signs of inflammation but nothing ominous. But, with these new symptoms, I’m a little more worried I’ll find Barrett’s Esophagus.
Barret’s Esophagus refers to an abnormal change in the cells of the lower portion of the esophagus and is thought to be an adaptation mechanism to the chronic exposure of acid reflux.
The cells of the esophagus are usually flat, but when they change to tall and columnar in their configuration on biopsy, that’s when Barrett’s is diagnosed.
Why is this important, you might be asking yourself? Because Barrett’s Esophagus has a very strong association with esophageal adenocarcinoma or esophageal cancer and once cancer develops, it’s really tough to treat.
The signs and symptoms of Barrett’s Esophagus can range from no symptoms at all to the following:
- frequent and longstanding heartburn
- trouble swallowing (dysphagia)
- vomiting blood (hematemesis)
- pain under the breastbone where the esophagus meets the stomach
- unintentional weight loss because eating is painful
The risk of developing Barrett’s is high among the obese, especially among those who wear their fat in their belly and the risk of it changing to cancer is highest among Caucasian men older than age 50 years old and who have had similar complaints like Bethany for more than 5 years.
If you have reflux disease, you should see a specialist for a screening endoscopy. But if you have known Barrett’s Esophagus, you should be seeing a gastroenterologist on a regular basis for surveillance endoscopies just to keep an eye on things.
I sent Bethany to the gastroenterologist and her biopsy was positive for Barrett’s Esophagus, but not cancer, thank goodness. So, she will need surveillance endoscopy and continued treatment with her proton pump inhibitor, Protonix.
Question: Will proton pump inhibitors such as Prilosec, Nexium, Protonix or H2 blockers like Prevacid reverse my Barrett’s Esophagus?
Answer: The answer is, unfortunately, no. There are no definitive treatments identified which are proven to reverse Barrett’s esophagus. Even though these medications may help your symptoms go away, they do not change the cells in the esophagus and therefore will do nothing to stop the possible progression to dysplasia or esophageal cancer. So, even in the absence of symptoms, patients with Barrett’s esophagus need to undergo surveillance endoscopy.
There are some research studies in the works which use a combination of laser or light ablation (cell removal) therapy in combination with these medications which have some promising results, but there is nothing definitive as of yet.
Question: I have Barrett’s Esophagus and was recently found to have high-grade dysplasia on an upper endoscopy. What are my treatment options?
Answer: There are many treatment options available for patients with Barrett’s esophagus with high-grade dysplasia, but the most definitive is surgical removal of the affected section of the esophagus. Other options include:
- Photodynamic therapy (PDT). Which uses light ablation and a reactive drug called Photofrin.
- Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.
- Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett’s cells.
- Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.
- Endoscopic mucosal resection. Another type of surgical removal of affected cells.
A combination of these therapies may also be used by your specialist.
I’m Dr. Ulin Sargeant. Thanks for taking A MINUTE FOR MEDICINE.