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The Importance of Endoscopy for Barrett’s Esophagus

If you have Barrett’s esophagus (BE), an upper endoscopy procedure is an important tool for monitoring this condition, minimizing your risk of developing esophageal cancer.

If you suffer from chronic heartburn or acid reflux, you face a higher risk of developing BE. GI doctors use an upper endoscopy (also called an EGD) to gather biopsies to diagnose this condition. An EGD is also an important tool for monitoring the progression of Barrett’s and the detection of changes in the esophageal lining or precancerous conditions.

 

Understanding Barrett’s Esophagus & Dysplasia

Barrett’s esophagus is the term used to describe the presence of changes in the esophageal lining wherein the cells take on characteristics of the lining of the small intestine. Although BE is not technically considered to be precancerous, it is the precursor to cell dysplasia (cells that appear abnormal, but are not currently cancerous), which may lead to esophageal cancer.

These changes occur when the esophagus is constantly exposed to stomach acid, typically due to gastroesophageal reflux disease, commonly known as GERD. Left untreated, acid reflux can lead to esophageal inflammation and, ultimately BE.

Who Is at Risk for Barrett’s Esophagus?

Although occasional heartburn is not unusual, experiencing chronic reflux (more than two times per week) can potentially increase your risk for BE. If you have been diagnosed with GERD, you are at risk for developing BE, especially if your reflux is not under control.

This condition is more common in men than women, and more common in Caucasians as it is in African Americans, but anyone can develop this condition.

Other common risk factors include smoking, alcohol consumption, obesity and the regular use of prescription or over-the-counter medications to control heartburn.

When Should You Have an Upper Endoscopy?

Although the chances of developing esophageal cancer are small, even in patients diagnosed with BE, this type of cancer has a high mortality rate. The American Cancer Society reports that, while more than 17,000 new cases are diagnosed each year, more than 16,000 Americans die each year due to cancer of the esophagus. Consequently, early detection is critical.

If you suffer from chronic heartburn, consult your Granite Peaks GI specialist to determine the appropriate course of action. Report any changes in symptoms, such as regurgitation, difficulty swallowing, hoarseness or worsening of asthma symptoms.

Granite Peaks Gastroenterology, with convenient locations in Lehi and Sandy, Utah, specializes in the treatment of conditions affecting the gastrointestinal tract, with an emphasis on helping our patients achieve overall health and wellness. Contact us today to learn more about Barrett’s esophagus. Your doctor will determine if an endoscopy procedure is indicated to diagnose, monitor and treat your upper gastrointestinal symptoms.

When Heartburn is More than Simple Indigestion

By Christopher S. Cutler, MD

How do you know when heartburn or “indigestion” is something more and needs to be treated? The gastroenterology specialists at Granite Peaks GI take time with their patients to determine if such symptoms may be a result of Gastroesophageal Reflux Disease (GERD). One of the red flags is heartburn occurring more than twice a week; although you can have GERD without the presence of heartburn. “If it is GERD, it needs to be diagnosed so further damage to the esophagus is minimized. There are also simple steps that can be taken to manage the disease and immediately improve one’s quality of life,” says Dr. Cutler, who explains more about the disease in the Q & A below.

What is GERD?

When we eat, food is carried from the mouth to the stomach through the esophagus. At the lower end of the esophagus where it joins the stomach there is a ring of muscle cells called the lower esophageal sphincter (LES). After swallowing, the LES relaxes to allow food to enter the stomach. Then, the LES contracts to prevent food and acid from traveling back up into the esophagus. GERD occurs when the LES weakens, allowing stomach contents and acid to back up into the esophagus, causing troubling symptoms or complications.

Who gets GERD and when should you see a doctor?

GERD affects ten million adults in the United States on a daily basis. People prone to developing it include those who are overweight, smokers or drinkers, and pregnant women. If symptoms are prolonged, or if you are unable to control the symptoms with lifestyle modifications and/or medications, you should see a gastroenterologist. Do so immediately if you have these warning symptoms: throwing up blood, passing black stool, difficulty swallowing, unexplained weight loss, or anemia.

What happens if you don’t treat GERD?

Untreated GERD may lead to the following complications: a narrowing of the esophagus which causes difficulty swallowing, ulcers which can cause bleeding, aspiration of acid into the lungs which may cause pneumonia or asthma, Barrett’s esophagus which is a precancerous lining of the esophagus, and esophageal cancer.

How is GERD treated? 

Lifestyle modifications, such as the following, can help decrease symptoms: raising the head of the bed (placement of 6-inch blocks under the head of the bed), waiting at least three to four hours after eating before lying down, avoiding tight-fitting clothing, avoiding smoking and alcohol, losing weight, and eating smaller, more frequent meals. Foods that can commonly aggravate GERD include: fatty foods, chocolate, peppermint, alcohol, caffeine, and citrus drinks. There may be other foods specific to each patient. Medication can also be used to help treat this condition, including antacids such as Mylanta or Maalox, H2 blockers such as Zantac or Tagamet, and proton pump inhibitors (PPIs) such as Prilosec or Prevacid.

How is GERD diagnosed? 

Your doctor may be able to diagnose this condition based upon your symptoms and response to therapy. If you have any of the classic warning symptoms mentioned above, your doctor may recommend an upper endoscopy. An upper endoscopy is a painless procedure performed under moderate sedation where a tiny lighted camera is passed through your mouth into your esophagus. Your gastroenterologist will be able to see whether there is damage to your stomach or esophageal tissue, and will be able to recommend a treatment plan to address your specific condition.

Talk to the experts at Granite Peaks Gastroenterology at our Sandy or Lehi office to help relieve your symptoms and determine the best course of action to treat your GERD.

Diagnosing GERD With the Bravo pH Test

By R. Kyle Barnett, MD

What is GERD?
Frequent heartburn may mean you have Gastroesophageal Reflux Disease (GERD), a condition that lead to serious health problems. It is estimated that 40 percent of Americans are impacted by GERD. Symptoms of GERD may include heartburn, regurgitation, chronic cough, hoarseness, sore throat, chest pain, belching, asthma, and difficulty swallowing.

Up to 26.5 percent of those with chronic GERD may develop Barrett’s Esophagus in their lifetime. Barrett’s Esophagus is the primary risk factor for Esophageal Cancer. Less than 20 percent of people diagnosed with esophageal cancer survive more than five years after their diagnosis.

How is GERD diagnosed?
GERD is often suggested based on your symptoms. However, diagnostic testing may also be needed to assess the severity of your symptoms, and to exclude other contributing factors such as hiatal hernia, inflammation or ulceration in the stomach, or tumor. An upper endoscopy (EGD) is the test performed by your doctor to visualize the lining of the esophagus, stomach and duodenum. Sometimes this test may be normal despite symptoms that suggest GERD. Sometimes medical treatment may not completely control your symptoms.

What is a Bravo pH test?
We have a reflux testing option that may help. It’s a convenient, safe and patient-friendly test that is performed in our outpatient Endoscopy Center. The Bravo pH Test measures the pH level in your stomach acid to help your doctor determine if your symptoms are related to acid reflux or if there is another cause. It will reveal whether your acid is being adequately controlled with medical therapy or if surgical correction may be the solution to your acid reflux. The Bravo test can also determine whether some of your other symptoms (chronic cough, recurrent sore throats, hoarseness, sinus issues, chest pain) are related to GERD.

How is the Bravo pH test performed?
The Bravo pH Test involves performing an upper endoscopy (EGD) with sedation administered by an Anesthesia Professional. During the EGD, a location for placement of a small pH probe is identified, and the probe is attached to the lower part of the esophagus, where it is monitored for a period of 48 hours. You leave our facility with a recording device that you keep with you for the duration of the test. You are then instructed to register your activities including eating and sleeping, and record when you develop symptoms including heartburn, chest pain or regurgitation. The recorder is then returned to our office, where Granite Peaks Gastroenterology physicians will then analyze the recording, along with your diary of events, and report back to you.

How can this help with my medical care?
The Bravo test can determine if an abnormal amount of acid is present in the esophagus, and whether your ongoing symptoms are related to GERD. It can also be an important part of your evaluation if you are considering surgery for your GERD. Although medical therapy for GERD is effective for most people, there have been some recent concerns about the long-term safety of these medications (called PPIs, or proton pump inhibitors) including possible increased risk of chronic kidney disease, bone loss, heart disease and increased risk of certain gastrointestinal infections. If long-term therapy is considered with these medications, it is important to determine if abnormal acid reflux is present so that the appropriate treatment plan can be made between you and your physician.

If reflux is an issue for you and you would like an evaluation to explore treatment options, call or click today to make an appointment. Together we can decide if you are a candidate for Bravo pH testing. For more information, please visit www.utahheartburnrelief.com.

Guidelines for the Diagnosis and Management of Barrett’s Esophagus

by Dr. Christopher Cutler

In 2015, the American College of Gastroenterology published clinical guidelines for the diagnosis and management of Barrett’s esophagus (BE). The following is a summary of this guideline which the physicians at Granite Peaks Gastroenterology would like to share with you:

  • —Screening of the general population for BE is not recommended.
  • —Screening for BE may be considered in men with chronic (>5 years) and/or frequent (weekly or more) symptoms of gastroesophageal reflux (heartburn or acid regurgitation) and two or more risk factors for BE. These risk factors include: age >50 years, Caucasian race, central obesity, current or past history of smoking, and a confirmed family history of BE or esophageal cancer (in a first degree relative).
  • —Screening for BE in females is not recommended. However, individualized screening could be considered in a woman with multiple risk factors for BE including: age>50, Caucasian race, chronic and/or frequent reflux symptoms, central obesity, current or past history of smoking, and a confirmed family history of BE or esophageal cancer (in a first degree relative).
  • —If the initial endoscopy is negative for BE, repeating an endoscopy to look for BE is not recommended. If the endoscopy reveals significant esophagitis, a repeat endoscopy after PPI (Prilosec) therapy for 8-12 weeks is recommended to ensure healing of esophagitis and exclude the presence of underlying BE.
  • —For BE patients without dysplasia (pre-cancerous cells), endoscopic surveillance should be performed every 3-5 years.
  • —For BE patients with dysplasia of any grade, the biopsies should be read by two pathologists, at least one of whom has expertise in GI pathology.
  • —For patients whose biopsies are indefinite for dysplasia, a repeat endoscopy after 3-6 months of optimized PPI therapy should be performed. If this endoscopy confirms the diagnosis of indefinite for dysplasia, a surveillance interval of 12 months is recommended.
  • —For patients with BE and confirmed low-grade dysplasia, endoscopic therapy (radiofrequency ablation) is considered the preferred treatment, although endoscopic surveillance every 12 months is an acceptable alternative.

—Patients with BE and confirmed high-grade dysplasia should be managed with endoscopic therapy (radiofrequency ablation +/- endoscopic mucosal resection).

—Endoscopic ablative therapies should not be routinely applied to patients with nondysplastic BE because of their low risk of progression to esophageal cancer.

—Patients with BE should receive once-daily PPI therapy. Routine use of twice-daily dosing is not recommended, unless necessitated because of poor control of reflux symptoms or esophagitis.

—Anti-reflux surgery should not be pursued in patient with BE to prevent cancer. However this surgery should be considered in those with incomplete control of reflux symptoms on optimized medical therapy.

—Endoscopic surveillance following elimination of BE for patients with low-grade dysplasia is recommended every 6 months for the first year, and annually thereafter.

—Endoscopic surveillance following elimination of BE for patients with high-grade dysplasia or intramucosal carcinoma is recommended every 3 months for the first year, every 6 months for the second year, and annually thereafter.

If you have any questions about Barrett’s esophagus or your reflux symptoms, please contact your physician at Granite Peaks Gastroenterology.

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