Digestive Health Barrett's esophagus

Subject: Digestive Health Barrett's esophagus Sun Jan 02, 2011 10:11 pm

Barrett's esophagus is a
condition in which the color and composition of the cells lining your
lower esophagus change, usually because of repeated exposure to stomach
acid.

Barrett's esophagus is most often diagnosed in people who have long-term
gastroesophageal reflux disease (GERD) — a chronic regurgitation of
acid from the stomach into the lower esophagus. Only a small percentage
of people with GERD will develop Barrett's esophagus.

A diagnosis of Barrett's esophagus can be concerning because it
increases the risk of developing esophageal cancer. Although the risk of
esophageal cancer is small, monitoring and treatment of Barrett's
esophagus focuses on periodic exams to find precancerous esophagus
cells. If precancerous cells are discovered, they can be treated to
prevent esophageal cancer.

Symptoms

Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:

* Frequent heartburn
* Difficulty swallowing food
* Chest pain
* Black, tarry stools
* Vomiting blood

Many people with Barrett's esophagus have no signs or symptoms.

When to see a doctor
If you've had long-term trouble with heartburn and acid reflux, discuss
this with your doctor and ask about your risk of Barrett's esophagus.

Seek immediate medical attention if you:

* Have chest pain
* Have difficulty swallowing
* Are vomiting red blood or blood that looks like coffee grounds
* Are passing black, tarry or bloody stools

Causes

The exact cause of Barrett's esophagus isn't known. Most people with
Barrett's esophagus have long-standing GERD. It's thought that GERD
causes stomach contents to wash back into the esophagus, causing damage
to the esophagus. As the esophagus tries to heal itself, the cells can
change to the type of cells found in Barrett's esophagus.

Still, some people diagnosed with Barrett's esophagus have never
experienced heartburn or acid reflux. It's not clear what causes
Barrett's esophagus in these cases.

Risk factors

Factors that increase your risk of Barrett's esophagus include:

* Chronic heartburn and acid reflux. Having these symptoms of
gastroesophageal reflux disease (GERD) for more than 10 years can
increase the risk of Barrett's esophagus. Stomach acid that backs up
into your esophagus if you have GERD can damage the esophageal tissue,
causing the changes that signal Barrett's esophagus.
* Being a man. Men are more likely to develop Barrett's esophagus.
* Being white or Hispanic. White and Hispanic people have a greater risk of the disease than do African-American people.
* Being an older adult. Barrett's esophagus is more common in older adults, but it can occur at any age.

Complications

Increased risk of esophageal cancer
People with Barrett's esophagus have an increased risk of esophageal
cancer. Still, the risk is small, especially in people whose pathology
reports show no precancerous changes (dysplasia) in their esophagus
cells. The overwhelming majority of people with Barrett's esophagus will
never develop esophageal cancer.

Studies of people with Barrett's esophagus show most think their risk of
esophageal cancer is much higher than it really is. This causes
needless worry and anxiety.

If you're worried about your risk of esophageal cancer, ask your doctor
to explain your chances of developing the disease. Also ask what you can
do to reduce your risk. This may help you feel more in control of your
health.

Preparing for your appointment

Barrett's esophagus is most often diagnosed in people with GERD who
undergo endoscopy exams to look for GERD complications. If your doctor
has discovered Barrett's esophagus on an endoscopy exam, you may be
referred to a doctor who treats digestive diseases (gastroenterologist).

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared for your
appointment. Here's some information to help you get ready for your
appointment, and what to expect from your doctor.

What you can do

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to absorb all the information provided during an
appointment. Someone who accompanies you may remember something that you
missed or forgot.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
Barrett's esophagus, some basic questions to ask your doctor include:

* Does my pathology report show dysplasia? If so, what is the grade of my dysplasia?
* Were my biopsy samples examined by a gastroenterological pathologist? Did two or more pathologists agree on the diagnosis?
* How much of my esophagus is affected by Barrett's dysplasia?
* Will I need to undergo another endoscopy exam to confirm my diagnosis?
* What is my risk of esophageal cancer?
* What are my options for reducing my risk of esophageal cancer?
* What are my treatment options for Barrett's esophagus?
* What are the benefits and risks of each treatment option?
* Do I have to have Barrett's esophagus treatment? What happens if I choose not to have treatment?
* Should I see a specialist? What will that cost, and will my insurance cover it?
* Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

Tests and diagnosis

Diagnosing Barrett's esophagus
Your doctor determines whether you have Barrett's esophagus using a procedure called upper endoscopy to:

* Examine your esophagus. Your doctor will pass a lighted tube
(endoscope) down your throat. The tube carries a tiny camera that allows
your doctor to examine your esophagus. Your doctor looks for signs that
the esophageal tissue is changing. A person with Barrett's esophagus
has tissue that appears different from normal esophageal tissue.
* Remove tissue samples. Your doctor may pass special tools through
the endoscope to remove several small tissue samples. The samples are
tested in a laboratory to determine what types of changes are taking
place and how advanced the changes are.

Determining the degree of tissue changes
A doctor who specializes in examining body tissue in a laboratory
(pathologist) will examine your esophageal tissue samples under a
microscope. The pathologist determines the degree of changes (dysplasia)
in your cells. Grades of dysplasia include:

* No dysplasia. If no changes are found in the cells, the pathologist determines there is no dysplasia.
* Low-grade dysplasia. Cells with low-grade dysplasia may show small signs of changes.
* High-grade dysplasia. Cells with high-grade dysplasia show many
changes. High-grade dysplasia is thought to be the final step before
cells change into esophageal cancer.

The type of dysplasia detected in your esophageal tissue determines your treatment options.

Treatments and drugs

Your treatment options for Barrett's esophagus depend on the grade of
changes in the cells of your esophagus, your overall health and your own
preferences.

Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:

*

Periodic endoscopy exams to monitor the cells in your esophagus.
How often you undergo endoscopy exams will depend on your situation.
Typically, if your biopsies show no dysplasia, you'll have a follow-up
endoscopy one year later. If your doctor again detects no dysplasia, you
may have endoscopy exams every three years. If low-grade dysplasia is
detected, your doctor may recommend GERD treatments and another
endoscopy in six months. If you're determined to have high-grade
dysplasia, then your doctor may offer other treatment options.

Sometimes when endoscopy is repeated, no evidence of Barrett's
esophagus is detected. This may not mean that the condition has gone
away. The affected portion of the esophagus could be very small, and it
may have been missed during the endoscopy. For this reason, your doctor
will still recommend follow-up endoscopy exams.
* Continued treatment for GERD. If you're still struggling with
chronic heartburn and acid reflux, your doctor will work to find
medications that help you control your signs and symptoms. Surgery to
tighten the sphincter that controls the flow of stomach acid may be an
option to treat GERD. This procedure is called Nissen fundoplication.
Treating acid reflux can reduce your signs and symptoms, but it doesn't
treat the underlying Barrett's esophagus.

Treatment for people with high-grade dysplasia
High-grade dysplasia is thought to be a precursor to esophageal cancer.
For this reason, doctors sometimes recommend more-invasive treatments,
such as:

* Surgery to remove the esophagus. During an esophagectomy, the
surgeon removes most of your esophagus and attaches your stomach to the
remaining portion. Surgery carries a risk of significant complications,
such as bleeding, infection and leaking from the area where the
esophagus and stomach are joined. When esophagectomy is performed by an
experienced surgeon, there's a reduced risk of complications. Still,
because of the potential complications of this major operation, other
treatments are usually preferred over surgery. One advantage to surgery
is that it reduces the need for periodic endoscopy exams in the future.
* Removing damaged cells with an endoscope. Endoscopic mucosal
resection is used to remove areas of damaged cells using an endoscope.
Your doctor guides the endoscope down your throat and into your
esophagus. Special surgical tools are passed through the tube. The tools
allow your doctor to cut away the superficial layers of the esophagus
and remove damaged cells. Endoscopic mucosal resection carries a risk of
complications, such as bleeding, tearing of the esophagus and narrowing
of the esophagus.
* Using heat to remove abnormal esophageal tissue. Radiofrequency
ablation involves inserting a balloon filled with electrodes in the
esophagus. The balloon emits a short burst of energy that burns the
damaged esophageal tissue.
* Destroying damaged cells by making them sensitive to light. Before
this procedure, called photodynamic therapy (PDT), you receive a
special medication through a vein in your arm. The medication makes
certain cells, including the damaged cells in your esophagus, sensitive
to light. During PDT, your doctor uses an endoscope to guide a special
light down your throat and into your esophagus. The light reacts with
medication in the cells and causes the damaged cells to die. PDT makes
you sensitive to sunlight and requires diligent avoidance of sunlight
after the procedure. Complications of PDT can include narrowing of the
esophagus, chest pain, difficulty swallowing and vomiting.

If you undergo treatment other than surgery to remove your esophagus,
there's a chance that Barrett's esophagus can recur. For this reason,
your doctor may recommend continuing to take acid-reducing medications
and having periodic endoscopy exams.

Lifestyle and home remedies

Most people diagnosed with Barrett's esophagus experience frequent
heartburn and acid reflux. Medications can control these signs and
symptoms, but changes to your daily life also may help. Consider trying
to:

* Maintain a healthy weight. If your weight is healthy, work to
maintain that weight. If you're overweight or obese, ask your doctor
about healthy ways to lose weight. Excess pounds put pressure on your
abdomen, pushing up your stomach and causing acid to back up into your
esophagus.
* Eat smaller, more frequent meals. Three meals a day, with small
snacks in between, will help you stop overeating. Continual overeating
leads to excess weight, which aggravates heartburn.
* Avoid tightfitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.
* Eliminate heartburn triggers. Everyone has specific triggers.
Common triggers such as fatty or fried foods, alcohol, chocolate,
peppermint, garlic, onion, caffeine and nicotine may make heartburn
worse.
* Avoid stooping or bending. Tying your shoes is OK. Bending over
for a long time to weed your garden may not be, especially soon after
eating.
* Don't lie down after eating. Wait at least three hours after eating to lie down or go to bed.
* Raise the head of your bed. Place wooden blocks under your bed to
elevate your head. Aim for an elevation of six to eight inches. Raising
your head by using only pillows isn't a good alternative.
* Don't smoke. Smoking may increase stomach acid. If you smoke, ask your doctor about strategies for stopping.

Coping and support

If you've been diagnosed with Barrett's esophagus, you may worry about
your risk of esophageal cancer. You may experience anxiety and worry
with each new sign or symptom. With time, you'll discover ways of coping
with a Barrett's esophagus diagnosis. Until then, consider trying to:

* Go to all of your appointments. Your doctor may recommend
follow-up endoscopy exams to monitor your condition. Before each exam,
you may worry about whether your Barrett's esophagus has worsened. Don't
let this stop you from going to your appointments. Instead, expect to
have some anxiety and find ways to cope with your feelings. Try relaxing
activities, such as exercise, listening to music and writing in a
journal to express your feelings.
* Make healthy lifestyle choices. Keep your body healthy by making
healthy lifestyle choices each day. For instance, choose a diet full of
fruits, vegetables and whole grains. Maintain a healthy weight. Exercise
most days of the week. Get enough sleep so that you wake feeling
rested. Making healthy changes increases the chance that you'll be
healthy enough for Barrett's esophagus treatment should you need it.
* Ask your doctor what symptoms to be alert for. Ask your doctor
what signs and symptoms should prompt you to make an appointment. This
way you may spend less time worrying that your condition is worsening.

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