Barrett's Esophagus Archive Questions

Below are Dr. Greenwald’s answers to Barrett's Esophagus questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 21.

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Q : 1 04/06/2010	Can a proton pump inhibitor help prevent cancer in patients with Barrett's Esophagus? Your podcast was very informative, but this wasn't mentioned. This is an excellent question without a clear answer. Some data does suggest that PPIs (proton pump inhibitors) may lower the risk of progression to esophageal cancer, but the data is not definitive. The other reason to use a PPI is for treatment of acid reflux. Some patients with Barrett's never notice any acid reflux, but we believe it could be the cause of the Barrett's in the first place. We tend to continue PPIs to prevent further acid reflux and possible increase in the Barrett's. The FDA has recently updated the information about PPIs with concerns about osteoporosis and other issues. However for most people the benefit outweighs the risk of use. I do urge my patients on PPIs to have their vitamin D levels checked and take a vitamin D supplement (1000 - 2000 units daily) along with a calcium supplement (1000 - 1500 mg daily).
Q : 2 03/28/2010	I was diganosed with Barrett's esophagus 10 years ago and had surgery to reconstruct the flap between my stomach and esophagus. The doctor at the time made it seem like it was cured and told me never to take ibuprofen again. I am now experiencing bloating and pain on the left side of the belly. My doctor says that I should have been taking medicine all this time and having it checked regularly. That's a long time not to keep on top of something I will have for the rest of my life. What could this mean for me? You should talk to your doctor about the pain. In general, the recommendation is to repeat endoscopy every 3 years and biopsy the Barrett's esophagus to assess for any precancerous changes. The main risk of not having this endoscopy is development of cancer/precancer, however the lifetime risk of cancer in people with Barrett's esophagus is only about 5%. If your endoscopy checks out, it is unlikely you have done any harm in waiting this long to have an endoscopy.
Q : 3 02/02/2010	I have suffered from acid reflux for my entire life. I take Nexium daily and that relieves my symptoms. However, if I miss a day, I get a burning sensation in my stomach, especially when leaning over. I figured this was simply related to gravity and the fact that my LES has never functioned properly. At what age do you recommend an endoscopy to check for Barrett's esophagus? The only other problem I have experienced was after drinking too much alcohol, I vomited and noticed that there was a bit of blood. There are no specific guidelines for when to start screening for Barrett's esophagus, and you don't mention your age. Given the significant amount of reflux you have had, I believe you should be under the care of a gastroenterologist for your condition. The vomiting blood was probably due to irritation or a tear in the esophagus or stomach, but this needs to be fully evaluated as well. I suspect it may be time now to perform an endoscopy given your symptoms.
Q : 4 11/13/2009	I have just been diagnosed with Barrett's esophagus. What kind of treatment should I pursue? I am currently taking Protonix twice a day. You should talk to your doctor about your specific treatment. In general, taking Protonix should get rid of your heartburn symptoms. Other things to do for heartburn include: don't over-eat, don't eat within 3 hours of bedtime, don't eat too many fatty or greasy foods, and lose weight if you are overweight. For Barrett's esophagus, repeating endoscopy and taking biopsy samples is generally done in one year, then every 3 years after that unless abnormal cells are found.
Q : 5 08/06/2009	Can Barrett's esophagus cause neck pain, shallow breathing and slight problems with swallowing? Barrett's esophagus is typically without any symptoms. Acid reflux (GERD) typically causes heartburn but may cause other symptoms including difficulty swallowing and throat pain. Neck pain and shallow breathing are not typical symptoms of Barrett's esophagus or GERD.
Q : 6 07/09/2009	Should a gastroscopy be done prior to starting Boniva when there has been no history of GERD to rule out Barrett's esophagus? An upper endoscopy (gastroscopy) is typically not recommended in this setting unless specific symptoms are found, such as heartburn or other GERD symptoms or trouble swallowing.
Q : 7 06/26/2009	I was diagnosed with Barrett's Esophagus in May. Is it possible to reverse it with lifestyle changes? Can normal cells grow back and replace the Barrett's cells? I have already lost 10 pounds and have changed some of my other eating habits. In general, Barrett's esophagus is not reversible with lifestyle changes or medicines. There are uncommon reports, though, of regression of the Barrett's tissue. You should continue with your lifestyle changes and weight loss, as this is important for treatment of acid reflux (GERD).
Q : 8 04/30/2009	I recently had an endoscopy done and was found to have Barrett's. The doctor found only a very small area and was hopeful that he removed it all w/ the biopsy. There was no dysplasia. He put me on Zantac, but I had severe headaches w/ it, so they took me off of this. I had been on prevacid for 5 yrs for severe reflux, but stopped it, since I have heard that long term use of any GERD med (zantac, prevacid etc.) can cause stomach/bowel cancer. Is it possible to remove all the cells with a biopsy or do they continue to return no matter what? My doctors feels monitoring me every 2 years is sufficient. Is this a typical plan? A very small amount of Barrett's tissue can be removed just by biopsy, but this is uncommon. We believe Barrett's esophagus is caused by acid reflux (GERD), so it can recur, especially if you have heartburn or acid reflux. In general, medicines like Prevacid are the most effective drugs, and there are no convincing studies that these drugs cause stomach/bowel cancer. Current guidelines suggest endoscopy should be done one year after the initial diagnosis, then every 3 years if Barrett's is still present and has no precancerous changes (dysplasia).
Q : 9 04/29/2009	I was diagnosed with Barrett's five years ago. Since then, I have had regular check-ups and I take Nexium daily. For the last two years, I have had increased problems swallowing and find myself choking very easily, even on my own saliva or while drinking water. My doctor says everything looks fine, but I am worried. Do you have any recommendations? I do not believe this problem is related to your Barrett's esophagus. Problems with choking when swallowing are more related to the muscles in the throat/upper esophagus. Evaluation for this can include an upper endoscopy (which you have probably already had), a barium esophagram or an assessment by a speech and swallowing expert (speech pathologist). I urge you to discuss this with your doctor and make him/her aware of the severity of the problem.
Q : 10 04/06/2009	Do you do cyrotherapy for metaplasia? At the present time, we are performing cryotherapy for esophageal metaplasia with high grade dysplasia. We are not performing the treatment for metaplasia with dysplasia.
Q : 11 03/20/2009	CSA is not yet available in the UK, which is where I am emailing from. My 82-year-old mother has had Squamous Oesophogeal cancer for about 6 months. She is still independent, pain-free and not suffering, but the tumor was inoperable. The problem is that despite having a stent fitted, she is struggling to eat and is losing weight. Clearly the outcome at the moment is likely to be death by malnutrition. I know that this is not an easy question to answer, but do you think she could be a candidate for CSA? Or is there something that would rule her out. She has had no other ailments in her life to speak of and until this manifested she was an extremely healthy octagenarian, regularly walking several miles at the weekend. If you think she could be a candidate, I would start investigating what we could do here in the UK with this treatment. Dear Simon, You are correct in that cryotherapy is not available in the UK. In most cases, placement of an esophageal stent results in significant improvement in the ability to swallow and eat. Recurrent problems with eating generally are due to progression of the tumor into the top or bottom of the stent (or less likely into the center of the stent if it is not the coated type). This progression narrows or blocks the opening of the esophagus. Treatment options in this setting include: placement of new stent in the area of blockage, use of laser or similar device to remove the tumor blocking the stent, or placement of a feeding tube (gastrostomy) directly into the stomach to allow nutrition even if one can not swallow. I urge you to discuss your mother's condition and treatment options with her doctors. The expertise of a gastroenterologist is generally needed for this type of problem.
Q : 12 03/19/2009	I have been diagnosed with Barrett's and also a "ring." I've had the throat scopes done and everything seems to be OK so far. I saw a tv program where a patient said he had no stomach. Is that possible? How does one survive with no stomach? The stomach is important for holding food and beginning digestion. However people survive without it. They typically must eat frequent small meals. The ring is a mild narrowing at the bottom of the esophagus, probably. It is associated with acid reflux disease. The ring may be stretched during endoscopy if a person as problems swallowing, usually solid foods.
Q : 13 03/09/2009	I am going to see my primary care physician and ask for a referral to see a physician regarding conditions I have been experiencing that are greatly concerning me. They are trouble swallowing and a continuing mild sore throat and occasional raspiness. I have an HMO and wanted to know your thoughts on going forward. I have read about throat cancer and I am very concerned. The symptoms have lasted about 4-5 months. I am a non-smoker, 47-year-old female. Can you please guide me to the next step? I believe you are correct in seeking a referral for your symptoms. A gastroenterologist is the appropriate specialist to evaluate your trouble swallowing, and they may be helpful for the throat symptoms. An ENT surgeon may also be consulted for the throat symptoms. I encourage you to see a specialist in a timely manner for your symptoms.
Q : 14 02/16/2009	I have stage I esophogeal cancer, having had radiation and am undergoing round 4 of chemo. Is ablation appropriate for stage one? I would like to look into this rather than undergoing radical surgery. In stage I esophageal cancer, the cancer is limited to the wall of the esophagus itself. In general, the treatment is removal of the esophagus (esophagectomy). At our institution, chemotherapy and radiation is used in those who are not able to have surgery. We have used cryotherapy in patients after radiation and chemotherapy if cancer is still present, and surgery is not an option. Without further information, I am not able to say whether cryotherapy is an option for you at this time. If you would like to discuss this further, please feel free to contact me.
Q : 15 12/21/2008	My husband (83 years old) was diagnosed with stage IIb esophageal cancer (a distal lymph node is malignant). The tumor is under the stomach and esophagus junction. Could he be a candidate for the procedure? Unfortunately, cryotherapy can not treat the cancer in the lymph node. In general, combination chemotherapy and radiation is offered in this setting if the person is in good shape. We have a multidisciplinary clinic that meets weekly to evaluate patients such as your husband. He would be evaluated by a medical oncologist (who would supervise chemotherapy), radiation oncologist (who would supervise radiation), and a thoracic surgeon at one visit.

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