If you suffer from chronic heartburn, consider an endoscopic examination to check for Barrett's esophagus
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By Dr. Robert Sewell, FACS
In 1977, as a young surgical resident, I was given anbrassignment to deliver a formal presentation to our entire faculty and all mybrfellow residents. My topic was cancer of the esophagus, which at that time wasbra relatively uncommon malignancy. In the course of my review of the literature,brI discovered that for the decades prior to the 1970's, about 95% of allbresophageal cancers were classified as squamous cell carcinoma. These tumorsbrtypically occur in the upper part of the esophagus and are more common inbrAfrican American men, pipe or cigar smokers, alcoholics, and in people who havebrsuffered either a thermal or chemical injury of the esophagus. At the time ofbrmy report, the remaining 5% of cancers consisted of what are calledbradenocarcinoma. These occur in the lower part of the esophagus, down near thebrstomach, and are commonly associated with chronic acid reflux also known asbr“Heartburn”.
Over the last 40 years things have changed significantly.brThe incidence of adenocarcinoma has been rising steadily, to the point wherebrtoday this type of cancer now accounts for the majority of esophagealbrmalignancies. A number of theories have been suggested as to why this dramaticbrchange has occurred, but there is no proof as to the actual cause. We know thatbrunlike squamous cell cancers, these tumors are more common in Caucasian men whobrhave chronic symptoms of acid reflux. Repeated acid injury is well known to bebrassociated with the development of a condition known as Barrett's esophagus,brwhere the esophageal lining changes into tissue that looks more like the liningbrof the stomach. These abnormal areas of mucosa are at further risk forbrundergoing additional changes that can culminate in adenocarcinoma. Althoughbrthe incidence of Barrett's esophagus is still relatively low in the populationbrin general, it has been steadily rising and along with it the risk of this typebrof cancer.
The presence of Barrett's changes can only be determined bybrinspecting the inside of the esophagus with an endoscope. This procedure is commonlybrreferred to by one of several different names: upper GI endoscopy, esophagogastroduodenoscopy,brEGD, or sometimes just a scope. There are some promising newbrendoscopic treatments available to treat Barrett’s, but in general the primarybrway to manage the problem is to aggressively control the reflux of acid frombrthe stomach up into the esophagus. This can be accomplished either with dailybrmedications that suppress stomach acid production, or by performing a surgicalbrprocedure to improve the function of the failed anti-reflux barrier between thebrstomach and esophagus.
Unfortunately, esophageal cancer has few if any earlybrsymptoms, but as it progresses patients typically complain of increasingbrdifficulty swallowing. These malignancies are extremely difficult to treatbrsuccessfully unless they are diagnosed very early, long before there are anybrsymptoms. The most effective treatment is often the surgical removal of thebresophagus, an extremely challenging and potentially disabling procedure.brRadiation and chemotherapy can also be used to treat patients.
So what's the bottom-line? If you suffer from chronicbrheartburn, even if its reasonably well controlled with either prescriptionbrmedications or over the counter drugs, you should, at some point, consider anbrendoscopic examination to check for Barrett's esophagus. This is especiallybrtrue if you are a Caucasian man over the age of 50, but actually anyone who hasbrchronic reflux is at risk.
Esophageal cancer is largely preventable, and controllingbryour acid reflux is the single most important thing you can do to protectbryourself. As you've heard on countless television ads for the various acid refluxbrmedications, it could be something more than just a little heartburn. If youbrhave any questions about Barrett's or esophageal cancer consult your doctor.
Robert Sewell, MD, FACS is a Board Certified and MASTER® Laparascopic Surgeon. He has resided in and provided surgical care to the North Texas Community for more than 30 years.