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Barrett's EsophagusPage 5
Looking for a medical problem in people who do not know whether they have one is called screening. Currently, there are no commonly accepted guidelines on who should have endoscopy to check for Barrett's esophagus. Among the many reasons for the lack of firm recommendations about screening are the great expense and occasional risk of side effects of the test. Also, the rate of finding Barrett's esophagus is low, and finding the problem early has not been proven to prevent deaths from cancer.
Many physicians recommend that adult patients who are over the age of 40 and have had gastroesophageal reflux disease (GERD) symptoms for a number of years have endoscopy to see whether they have Barrett's esophagus. Screening for this condition in people who have no symptoms is not recommended.
Treatment
Barrett's esophagus has no cure, short of surgical removal of the esophagus, which is a serious operation. Surgery is recommended only for people who have a high risk of developing cancer or who already have it. Most physicians recommend treating gastroesophageal reflux disease (GERD) with acid blocking drugs, since this is sometimes associated with improvement in the extent of the Barrett's tissue. However, this approach has not been proven to reduce the risk of cancer. Treating reflux with a surgical procedure for gastroesophageal reflux disease (GERD) also does not seem to cure Barrett's esophagus.
Several different experimental approaches are under study. One attempts to see whether destroying the Barrett's tissue by heat or other means through an endoscope can eliminate the condition. This approach, however, has potential risks and unknown effectiveness.
Surveillance for Dysplasia and Cancer
Periodic endoscopic examinations to look for early warning signs of cancer are generally recommended for people who have Barrett's esophagus. This approach is called surveillance. When people who have Barrett's esophagus develop cancer, the process seems to go through an intermediate stage in which cancer cells appear in the Barrett's tissue. This condition is called dysplasia and can be seen only in biopsies with a microscope. The process is patchy and cannot be seen directly through the endoscope, so multiple biopsies must be taken. Even then, it can be missed.
The process of change from Barrett's to cancer seems to happen only in a few patients, less than 1 percent per year, and over a relatively long period of time. Most physicians recommend that patients with Barrett's esophagus undergo periodic surveillance endoscopy to have biopsies. The recommended interval between endoscopies varies depending on specific circumstances, and the ideal interval has not been determined.
Treatment for Dysplasia or Esophageal Adenocarcinoma
If a person with Barrett's esophagus is found to have dysplasia or cancer, the doctor will usually recommend surgery if the person is strong enough and has a good chance of being cured. The type of surgery may vary, but it usually involves removing most of the esophagus and pulling the stomach up into the chest to attach it to what remains of the esophagus. Many patients with Barrett's esophagus are elderly and have many other medical problems that make surgery unwise; in these patients, other approaches to treating dysplasia are being investigated.
Page 1 Barrett's Esophagus
Page 2 Barrett's Esophagus
Page 3 Barrett's Esophagus
Page 4 Barrett's Esophagus
Page 5 Barrett's Esophagus
Page 6 Barrett's Esophagus - Conclusion
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