Dr. Eisner Answers Your GERD Questions: Barrett's Esophagus
I was a long-time sufferer with heartburn and was diagnosed with Barrett's esophagus a few years ago. While my symptoms have been under control, I worry about esophageal cancer. Do any drugs prevent the development of esophageal cancer in patients with Barrett's esophagus?
It has long been felt that medications could not prevent the progression of Barrett's esophagus to cancer. Initial reports of a current study in progress in the United Kingdom is looking at whether treatment with aspirin and Nexium can stop Barrett's from progressing to cancer. The study has been ongoing since 2005, and while it is unclear as of yet as to whether the drug combination is efficacious, what has come out is that the use of aspirin in patients with Barrett's esophagus is safe and well tolerated. While some patients have experienced increased incidences of heartburn, requiring an increased dosage of Nexium, few have dropped out of the study. This was an important step, as there were fears that the use of aspirin might worsen esophagitis and increase the incidence of gastrointestinal bleeding. You should check with your doctor as to whether he recommends the use the at least low dose aspirin to possibly prevent the development of esophageal cancer.
Can Barrett's esophagus be diagnosed by x-ray or any other non-invasive test, or is upper endoscopy required?
The diagnosis of Barrett's esophagus requires the direct visualization of the lining of the esophagus. This is not possible by esophagram or upper gastrointestinal series. Recently, however, a new test, the Pillcam Eso, has been developed which non-invasively visualizes the lining of the esophagus. The PillCam Eso is a smooth plastic capsule about the size of a large vitamin pill that has tiny video cameras at each end. A patient lies on his or her back and swallows the pill with water. The pill then glides down the esophageal tract taking about 2,600 color pictures (14 per second), which are transmitted to a recording device worn by the patient. After 20 minutes, the doctor has enough video images to make a definitive diagnosis. The disposable capsule is passed naturally, usually within 24 hours. The procedure will allow patients with heartburn to be screen for Barrett's esophagus. Once a diagnosis of Barrett's esophagus is made, patients will need to undergo endoscopy to allow biopsies to be taken looking for dysplasia, so that patients can be stratified for potential for development of esophageal cancer. The advantage of the test however, would be that if Barrett's is not seen on the video, then endoscopy will be avoided. Currently, approximately 10% of patients with chronic heartburn are found to have Barrett's esophagus. You should check with your doctor to see if you are a good candidate for Pillcam Eso.
I was recently started on estrogen replacement therapy, and have noticed worsening of my symptoms of gastroesophageal reflux disease. Is there any relationship?
A recent study published in the April 2008 issue of Gastroenterology suggested that postmenopausal estrogen therapy appears to increase the risk of developing symptoms of gastroesophageal reflux disease. The study looked at hormone therapy use and reflux symptoms in over 24,000 female subjects in Sweden. Patients who had ever used post-menopausal estrogen therapy were 32% more likely to report reflux symptoms than those who had never taken such therapy. Higher body mass slightly increased the risk for reflux, but even lean women had a 21% increased risk of symptoms. The risk was less in patients that were on combined estrogen and progesterone therapy, as opposed to estrogen therapy alone. Interestingly, this sheds light on the cause of increased reflux symptoms in pregnancy. While originally felt to be predominantly related to an increased abdominal pressure, it now appears that exposure to hormones plays a significant role as well. You should check with your doctor to see if safe adjustments can be made to your post-menopausal hormone therapy.
Read another expert post about treatment for Barretts Esophagus by clicking here.