GERD complication and Barrett’s esophagus with dysplasia speed up esophageal cancer risk, according to new findings. Researchers found esophageal cancer risk to be eight times higher in those with Barrett’s esophagus with dysplasia. Dr. Rajesh Krishnamoorthi from the Mayo Clinic reported at the American College of Gastroenterology 2015 Annual Meeting, “Barrett’s esophagus subjects with low-grade dysplasia diagnosis reconfirmed by expert GI pathologists may be candidates for endoscopic therapy.” Recommended management strategy for these patients is endoscopic ablation.
Researchers examined 952 patients with esophageal adenocarcinoma and evaluated if low-grade dysplasia was associated with a progression risk for esophageal cancer. Gastrointestinal pathologists reviewed demographic data, endoscopic findings, histologic data, and biopsy samples from the index diagnosis of low-grade dysplasia. From their findings they were able to group the patients into one of five groups: confirmed low-grade dysplasia, adenocarcinoma, high-grade dysplasia, indefinite dysplasia, or no-dysplasia Barrett’s esophagus.
Over the 7.8 year follow-up 15 patients progressed to high-grade dysplasia. Risk progression was higher in confirmed low-grade and indefinite dysplasia than the no-dysplasia group.
What is Barrett’s esophagus?
Barrett’s esophagus is often diagnosed as a complication of gastroesophageal acid reflux disease (GERD). It occurs when the tissues in the esophagus – the tube connecting the mouth to the stomach – are replaced by tissue similar to the intestines.
Dysplasia is a precancerous condition where cells grow similar to cancer growth, but do not yet have the ability to invade the tissue. Dysplasia can be treated and cured before it becomes cancerous.
Barrett’s esophagus causes and symptoms
An exact cause of Barrett’s esophagus is unknown but many individuals with the condition have a long history of GERD. In GERD, acid reflux occurs when acid from the stomach pushes up into the esophagus, which can damage the tissue of the esophagus. In an attempt to heal itself, the cells in the esophagus change until they are similar to intestine cells, which are found in Barrett’s disease.
There are some cases of Barrett’s disease where acid reflux does not occur and, unfortunately, doctors do not know what the underlying cause is.
Symptoms of Barrett’s esophagus are:
- Frequent heartburn
- Difficulty swallowing food
- Chest pain – but not as common
More often than not individuals won’t experience symptoms of Barrett’s esophagus.
Barrett’s esophagus treatment
Treatment of Barrett’s esophagus depends on whether dysplasia is present. If dysplasia is not present or is low-grade, treatment options are as follows:
Periodic endoscopy to monitor cells in the esophagus: If biopsies do not reveal dysplasia, follow-up scopes will be conducted every one to three years. If dysplasia is found, follow-up scopes may be conducted every six months.
Treatment of GERD: Because Barrett’s esophagus is often a complication of GERD, it’s important to treat GERD to ensure it does not worsen. Treatment of GERD can involve medication and lifestyle changes. Surgery may be required to tighten the sphincter, which allows the stomach acid to flow through.
In high-grade dysplasia, treatment can involve one of the following:
Endoscopic resection: Damaged cells are removed endoscopically.
Radiofrequency ablation: Heat is used to remove abnormal esophagus tissue.
Cryotherapy: Cold liquid or gas is applied to abnormal cells and then they are warmed up. The cycle of freezing and heating up damages abnormal cells.
Photodynamic therapy: Abnormal cells are destroyed by becoming sensitive to light.
Surgery: The damaged part of the esophagus is removed and then the esophagus is reattached to the stomach.
Barrett’s esophagus diet
Although a specific diet and nutrition plan has not been discovered to prevent Barrett’s esophagus, there are certain foods that can aid in the management of GERD. Dietary changes that can help reduce the symptoms of GERD include decreasing fatty foods and eating small, frequent meals rather than three large ones.
Avoiding the following foods can also help you manage GERD and Barrett’s esophagus.
- Greasy or spicy foods
- Tomatoes and tomato products
- Alcoholic drinks
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