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P. 98
Is it heartburn
OR IS IT SOMETHING MORE SINISTER?
The Story of Barrett’s Esophagus
by Susan Liberski, MD
H eartburn symptoms are very common. Just walk down the development of Barrett’s. Obesity, especially belly fat,
aisle of your local grocery or discount store and you’ll see alcohol consumption and smoking increase the risk
shelves of over the counter (OTC) medications for heartburn
of developing Barrett’s although some authorities
and acid indigestion. You probably know the feeling, burning in the also feel our genetics play a major role.
chest, discomfort in the upper abdomen, acid taste in the throat. These SO HOW IS BARRETT’S
symptoms can happen after eating late at night or having one too
many glasses of holiday cheer at the last cocktail party. Intermittent ESOPHAGUS DIAGNOSED?
heartburn, easily relived by OTC agents usually isn’t a health risk or The most reliable way of diagnosing Barrett’s is by
long term problem. However if these symptoms happen frequently, performing an EGD (esophagogastroduodenoscopy).
perhaps the problem isn’t heartburn but Gastroesophageal Reflux This procedure is a lighted tube that is passed down through the mouth
Disease (GERD). into the esophagus, stomach and duodenum. The gastroenterologist
GERD is also a common condition. It is estimated that about one who performs this examination can take biopsies of the esophagus
third of the adult population in the USA suffers from GERD. The to look for the precancerous cells. The cells, once examined by a
disease is characterized by frequent heartburn (one or more times a pathologist, can determine if Barrett’s esophagus is present and if there
week) that happens because of inappropriate relaxation of the muscle is the presence of dysplasia. Dysplasia is the appearance of the cells that
that separates the esophagus from the stomach, the lower esophageal look even more abnormal and more cancer like and can be classified
sphincter (LES). Our stomachs are designed to produce acid in as low and high grade. If no dysplasia is present on the biopsies, the
response to eating to help our food digest. If the LES stays open while treatment includes treatment of the GERD with PPI medications and
the stomach is producing acid, we get the symptoms of GERD. Lifestyle surveillance EGD every 2-3 years. If the GERD symptoms are severe
choices which can make GERD worse include obesity, eating late at and don’t respond to PPI medications, sometimes referral for antireflux
night, the use of caffeine, alcohol, chocolate, overly spicy or acidic foods surgery is indicated. Research has failed to show that surgical treatment
and smoking. Structural changes in the body such as a hiatal hernia of GERD in a Barrett’s patient prevents the development of esophageal
(where part of the stomach sits above the diaphragm) or pregnancy can adenocarcinoma.
also make GERD symptoms worse. There are also atypical GERD Once dysplasia is present, the game changes as this patient is at high
symptoms which include chronic laryngitis, chronic cough and asthma; risk to develop esophageal cancer. These patients are followed more
all a part of the disease called LPR (laryngeal pharyngeal reflux) and aggressively with more frequent EGD, multiple biopsies to determine
these patients may not even have typical heartburn at all. Common if the dysplasia is low grade, high grade or signs of carcinoma in situ.
treatments for GERD include lifestyle changes and use of agents Treatments of dysplasia have changed in the last few years. The use
such as antacids, histamine receptor antagonists (the H2 Blockers- of radiofrequency ablation, the “HALO” procedure, has been FDA
cimetidine, ranitidine and famotidine) or more potent medications approved for the treatment of Barrett’s with dysplasia. An EGD
like the proton pump inhibitors (PPI- omeprazole, lansoprazole, is performed and an electrode is passed through the scope to ablate
pantoprazole, rabeprazole, esomeprazole and dexlansoprazole). People the Barrett’s tissue. Frequent endoscopy, retreatment with the device
who suffer from frequent heartburn and GERD may seek the advice of and aggressive treatment of GERD is recommended to attempt to
a gastroenterologist to know which treatment, length of treatment and prevent adenocarcinoma. If it is determined on biopsy that a small
what further testing is needed to make the patient more comfortable as cancer, carcinoma in situ, is present, an endoscopic ultrasound may be
well as be sure there are no other serious consequences. recommended to determine the depth of the cancerous cells into the
Barrett’s esophagus is one of the most serious complications of wall of the esophagus which determines further treatments.
GERD and can develop in 5-10% of patients with GERD. Barrett’s WHAT IF CANCER IS PRESENT?
esophagus is a precancerous condition where the cells lining the
esophagus (squamous epithelium) are replaced with cells that look Treatment of adenocarcinoma of the esophagus is difficult.
similar to cells in the lining of the small intestine (columnar epithelium). Combinations of radiation therapy, chemotherapy and surgery for
Although we know that Barrett’s is seen in patients who have GERD, removal of some or the entire esophagus are may be indicated. This
not all Barrett’s patients have frequent GERD symptoms and the aggressive treatment has been shown to improve quality and length of
development of Barrett’s is not necessarily based on the frequency life in patients with esophageal cancer.
or severity of symptoms. Barrett’s esophagus increases the risk of In summary, Heartburn and GERD are common. If you
adenocarcinoma of the esophagus. Most patients with adenocarcinoma have frequent heartburn, talk to your doctor to see if referral to a
of the esophagus have underlying Barrett’s tissue, however less than one gastroenterologist is warranted to determine if Barrett’s esophagus is
percent of Barrett’s patients develop cancer. It has never been determined present. It may save your life.
what triggers the cells in the esophagus to change into the Barrett’s For more information, please contact Dr Liberski at sliberski@comcast.
mucosa and treating GERD with lifestyle changes may not prevent the net.
98 Life in Naples | January 2015
OR IS IT SOMETHING MORE SINISTER?
The Story of Barrett’s Esophagus
by Susan Liberski, MD
H eartburn symptoms are very common. Just walk down the development of Barrett’s. Obesity, especially belly fat,
aisle of your local grocery or discount store and you’ll see alcohol consumption and smoking increase the risk
shelves of over the counter (OTC) medications for heartburn
of developing Barrett’s although some authorities
and acid indigestion. You probably know the feeling, burning in the also feel our genetics play a major role.
chest, discomfort in the upper abdomen, acid taste in the throat. These SO HOW IS BARRETT’S
symptoms can happen after eating late at night or having one too
many glasses of holiday cheer at the last cocktail party. Intermittent ESOPHAGUS DIAGNOSED?
heartburn, easily relived by OTC agents usually isn’t a health risk or The most reliable way of diagnosing Barrett’s is by
long term problem. However if these symptoms happen frequently, performing an EGD (esophagogastroduodenoscopy).
perhaps the problem isn’t heartburn but Gastroesophageal Reflux This procedure is a lighted tube that is passed down through the mouth
Disease (GERD). into the esophagus, stomach and duodenum. The gastroenterologist
GERD is also a common condition. It is estimated that about one who performs this examination can take biopsies of the esophagus
third of the adult population in the USA suffers from GERD. The to look for the precancerous cells. The cells, once examined by a
disease is characterized by frequent heartburn (one or more times a pathologist, can determine if Barrett’s esophagus is present and if there
week) that happens because of inappropriate relaxation of the muscle is the presence of dysplasia. Dysplasia is the appearance of the cells that
that separates the esophagus from the stomach, the lower esophageal look even more abnormal and more cancer like and can be classified
sphincter (LES). Our stomachs are designed to produce acid in as low and high grade. If no dysplasia is present on the biopsies, the
response to eating to help our food digest. If the LES stays open while treatment includes treatment of the GERD with PPI medications and
the stomach is producing acid, we get the symptoms of GERD. Lifestyle surveillance EGD every 2-3 years. If the GERD symptoms are severe
choices which can make GERD worse include obesity, eating late at and don’t respond to PPI medications, sometimes referral for antireflux
night, the use of caffeine, alcohol, chocolate, overly spicy or acidic foods surgery is indicated. Research has failed to show that surgical treatment
and smoking. Structural changes in the body such as a hiatal hernia of GERD in a Barrett’s patient prevents the development of esophageal
(where part of the stomach sits above the diaphragm) or pregnancy can adenocarcinoma.
also make GERD symptoms worse. There are also atypical GERD Once dysplasia is present, the game changes as this patient is at high
symptoms which include chronic laryngitis, chronic cough and asthma; risk to develop esophageal cancer. These patients are followed more
all a part of the disease called LPR (laryngeal pharyngeal reflux) and aggressively with more frequent EGD, multiple biopsies to determine
these patients may not even have typical heartburn at all. Common if the dysplasia is low grade, high grade or signs of carcinoma in situ.
treatments for GERD include lifestyle changes and use of agents Treatments of dysplasia have changed in the last few years. The use
such as antacids, histamine receptor antagonists (the H2 Blockers- of radiofrequency ablation, the “HALO” procedure, has been FDA
cimetidine, ranitidine and famotidine) or more potent medications approved for the treatment of Barrett’s with dysplasia. An EGD
like the proton pump inhibitors (PPI- omeprazole, lansoprazole, is performed and an electrode is passed through the scope to ablate
pantoprazole, rabeprazole, esomeprazole and dexlansoprazole). People the Barrett’s tissue. Frequent endoscopy, retreatment with the device
who suffer from frequent heartburn and GERD may seek the advice of and aggressive treatment of GERD is recommended to attempt to
a gastroenterologist to know which treatment, length of treatment and prevent adenocarcinoma. If it is determined on biopsy that a small
what further testing is needed to make the patient more comfortable as cancer, carcinoma in situ, is present, an endoscopic ultrasound may be
well as be sure there are no other serious consequences. recommended to determine the depth of the cancerous cells into the
Barrett’s esophagus is one of the most serious complications of wall of the esophagus which determines further treatments.
GERD and can develop in 5-10% of patients with GERD. Barrett’s WHAT IF CANCER IS PRESENT?
esophagus is a precancerous condition where the cells lining the
esophagus (squamous epithelium) are replaced with cells that look Treatment of adenocarcinoma of the esophagus is difficult.
similar to cells in the lining of the small intestine (columnar epithelium). Combinations of radiation therapy, chemotherapy and surgery for
Although we know that Barrett’s is seen in patients who have GERD, removal of some or the entire esophagus are may be indicated. This
not all Barrett’s patients have frequent GERD symptoms and the aggressive treatment has been shown to improve quality and length of
development of Barrett’s is not necessarily based on the frequency life in patients with esophageal cancer.
or severity of symptoms. Barrett’s esophagus increases the risk of In summary, Heartburn and GERD are common. If you
adenocarcinoma of the esophagus. Most patients with adenocarcinoma have frequent heartburn, talk to your doctor to see if referral to a
of the esophagus have underlying Barrett’s tissue, however less than one gastroenterologist is warranted to determine if Barrett’s esophagus is
percent of Barrett’s patients develop cancer. It has never been determined present. It may save your life.
what triggers the cells in the esophagus to change into the Barrett’s For more information, please contact Dr Liberski at sliberski@comcast.
mucosa and treating GERD with lifestyle changes may not prevent the net.
98 Life in Naples | January 2015
