Chronic heartburn, Barrett’s esophagus and esophageal cancer

The following post was written by Neil Sharma, MD, president, Parkview Cancer Institute.

The most common form of esophageal cancer in the Western Hemisphere, adenocarcinoma of the esophagus, primarily affects Caucasian men over the age of 55, as well as people with gastroesophageal reflux disease (GERD). Adenocarcinoma of the esophagus is the fastest growing cancer in America in number of new cancer cases per year.

How do I know if I have normal heartburn or a potentially precancerous condition?

The most common symptom of GERD is heartburn, a condition that more than 30 million Americans experience daily. Everyday heartburn can lead to changes in the lining of the esophagus that increases the risk of developing esophageal cancer. The change in the lining is a condition called Barrett’s esophagus. It is believed that most cases of this type of esophageal cancer begin as Barrett’s esophagus.

Even if you treat heartburn by taking medicine to control the symptoms, you can still potentially develop Barrett’s. Having Barrett's esophagus raises the risk for esophageal cancer.

Barrett’s is diagnosed by performing an upper endoscopy. A specialized gastroenterologist with experience in GERD and endoscopy of the upper GI tract should perform the initial consultation.

Upper endoscopy can also detect inflammation of the esophagus, ulcers, or narrowing of the esophagus, called a stricture.

If the physician suspects Barrett's esophagus, the doctor might want to test for it by pursuing biopsies of the lining of the esophagus at intervals to check for cells that could develop into cancer. These tests could include endoscopy and doing a biopsy of any abnormal cells.

If the biopsies show mutations, called dysplasia, or the area is suspicious to your GI doctor, they might refer you to another GI subspecialist on the team, an interventional endoscopist.

If the biopsies do not show dysplasia and it’s a very short length of Barrett’s, your GI specialist might place you under surveillance via routine endoscopies with biopsies.

What is Barrett’s esophagus?

In Barrett's esophagus, the cells that line the inside of the esophagus are replaced by cells like those that line the inside of the stomach. This change in the type of cell can occur with long-term exposure of the esophagus to stomach acids, such as from chronic GERD. The new cells are more resistant to stomach acid. But inflammation, sores and bleeding can still occur in that part of the esophagus.

It’s estimated that 5-15 percent of patients with chronic reflex may develop Barrett’s esophagus.  Some will have symptoms and others will not.

Not all Barrett’s esophagus will develop into esophageal cancer. Therefore, all Barrett’s should have surveillance via endoscopy. “Short segment” Barrett’s is 3 centimeters or less in length (2.4 centimeters is equal to 1 inch). Short segment Barrett’s requires careful surveillance with biopsies and other specialized lighting and tools done via endoscopy. This can be performed by an experienced gastroenterologist.

For patients with long segment Barrett’s (greater than 3 centimeters), it is possible to consider eradication. This should be based on a careful history, examination and perhaps repeat endoscopy. You should carefully discuss the risks and benefits of eradication. Sometimes the interval of surveillance is decreased rather than eradicating the Barrett’s. For all patients with biopsies showing dysplasia (mutations on biopsy seen by the pathologist), eradication is the recommendation.

How can Parkview support my treatment?

Parkview has subspecialized expertise in interventional endoscopy via the Interventional Endoscopic Oncology & Surgical Endoscopy (IOSE) service. The service, which I established in 2013, has grown tremendously and currently performs the most treatments of Barrett’s esophagus in the region. These physicians have performed an additional fellowship focused on the treatment of precancerous and cancerous conditions and other minimally invasive surgical procedures done by endoscopy.

The eradication of Barrett’s esophagus can be performed by cutting tissue (resection), nursing tissue via radiofrequency ablation, or freezing tissue via cryoablation, or some combination of the three.

At Parkview, we offer nationally recognized expertise in Barrett’s esophagus and esophageal cancer. We have treated patients from Ohio, Michigan and Indiana. We are currently offering multiple trials for both conditions.  We have published papers, give routine second opinions, and have the expertise to get you the best possible outcomes. 

 

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