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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 37.

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Q : 1

Is Barrett's hereditary?

This is an interesting question, and we do not have a good answer. There are families where multiple members have Barrett's. We presume there are hereditary factors, but we do not know what they are yet.

Q : 2

Do you recommend Cryotherapy ablation of the esophagus for low grade Barrett's disease?

The bigger decision here is whether any ablation or resection procedure should be used in low-grade dysplasia. I follow the recent Barrett's esophagus guidelines published by the American Gastroenterological Association ( These guidelines state, "Endoscopic eradication therapy with RFA should also be a therapeutic option for treatment of patients with confirmed low-grade dysplasia in Barrett's esophagus. We recognize the controversies surrounding both definition and management of dysplasia in Barrett's esophagus and that the risk of progression to cancer in this population of patients can vary greatly among individuals. The AGA Institute strongly supports the concept of shared decision making where the treating physician and patient together consider whether endoscopic surveillance or eradication therapy is the preferred management option for each individual." In addition, I recommend that the biopsy samples be reviewed by an expert GI pathologist to confirm dysplasia, and that dysplasia be found on two separate endoscopies before proceeding with an ablation discussion.

Q : 3

I have had yearly scopes since 2002. The last three EGD's the doctor said it looks like I have a small segments of Barrett's, but the biopsies are always negative. Is this a common issue?

It is hard to give a precise answer in your case without the endoscopy report and images. However, this is common. The border between the esophagus and the stomach is called the Z-line (because it zigzags). If the zigzagging is prominent, it can look like Barrett's tissue, and the only way to know if it is really Barrett's is with a biopsy. If the biopsies on multiple EGDs are normal, it is very unlikely that Barrett's esophagus is present.

Q : 4

I was diagnosed with a short segment of Barrett's with no dysplasia in 2009. I recently had another endoscopy with a new doctor and she felt the Barrett's looked better from the last report, so she didn't biopsy the area. Is this a normal course of action?

Current recommendations by the AGA (American Gastroenterological Association) and the ACG (American College of Gastroenterology) are to perform biopsies every 1-2 cm along the length of the Barrett's segment in 4 quadrants. I am not sure why your doctor did not feel the need to perform a biopsy at your endoscopy. It is generally not possible to identify any early precancerous changes without biopsy.

Q : 5

I have Barrett's and was just told I have arthritis in my knee. Is Tylenol safe to take? Any other alternatives?

Tylenol (acetaminophen) does not have any known effect on Barrett's esophagus. It should be taken in prescribed doses, as too much Tylenol can cause injury to the liver.

Q : 6

Can cryotherapy ablation be performed on a patient with Barrett's esophagus with low-grade dysplasia? In the materials I've read, it only mentions it as a treatment for patients with high-grade dysplasia.

It is possible to ablate Barrett's esophagus for a patient with low-grade dysplasia, either with cryotherapy or with radiofrequency ablation (BARRX Halo device). Whether or not to do so remains controversial. Most people with low-grade dysplasia never progress to cancer, and two-thirds of those found to have low-grade dysplasia don't have it on next EGD. However, in some patients, the risk of developing cancer with low-grade dysplasia may be higher. We don't have great ways to determine who is in the high risk group, but we use an expert pathologist review of the findings, presence of nodules, and how long the dysplasia has been present as markers. Some insurance providers do not pay for ablation for low-grade dysplasia, so this must be considered as well.

Q : 7

Can taking proton pump inhibitors actually increase your risk of getting esophageal cancer? I read about a study that found that people who have Barrett's and take PPIs and have few reflux symptoms are more likely to have cancer.

I agree that this is a confusing study. The design of the study can not prove that PPIs cause/increase risk of cancer but can only show an association. I am sure more studies will be coming to look at this. I suspect that people with more severe GERD are getting PPIs and endoscopies, and their cancers are being discovered early or before they become cancer (high-grade dysplasia) and are being treated with ablation. Those without significant GERD (but who have Barrett's) are not on PPIs and do not get endoscopies, so their cancers are not being discovered until later stages. I personally do not believe that PPIs increase risk of esophageal cancer, but I will be keeping an eye on the data to come.

Q : 8

I'm 74 years old and have just been diagnosed with esophageal cancer. My doctor said that he expects I'll need radiation and chemo. Could I be a candidate for cryotheropy prior to and during my chemo and radiation treatments.

I do not recommend cryotherapy during chemotherapy and radiation, because it is not likely to improve on the effects of the chemo and radiation for killing the tumor. I sometimes do cryotherapy before treatment to help open the esophagus if needed. After radiation and chemo, cryotherapy may be useful to treat any residual cancer if you are not a candidate for surgery (esophagectomy). If you do not have surgery, it is important that endoscopy be performed every 6 months or so to check for any residual cancer or precancerous changes.

Q : 9

My brothers and sisters all have Barrett's. The youngest brother just received a diagnosis of HGD after multiple procedures in the last two months to "stretch" his throat. It seems the doctor was able to go down farther each time and the last biopsy produced the HGD. If HGD is found this way, could there also be cancer even lower? How would this be found? Could HGD be an inherited tendency for those with Barrett's?

Cancer can be found in follow-up biopsy when HGD alone is found initially. Ideally, biopsies are taken according to recommended protocols when HGD is found to minimize that risk. Your brother should be seen by doctor who is an expert in this condition. While surgery is the traditional option for managing this, ablation or endoscopic mucosal resection are also successful in many cases and can avoid the need for surgery.

Q : 10

If my esophageal biopsy was negative for Barrett's esophagus but showed "intense acute and chronic inflammation of the stroma with associated glandular atypia that is indefinite for dysplasia;" why would my GI doctor send me to a specialist to do another biopsy with a dye study to see how much of the area is involved? Doesn't Barrett's esophagus have to be positive for results to be concerning?

In the setting of inflammation, it can be very difficult to interpret findings on a biopsy, including the possibility of dysplasia (a precancerous change) or whether the tissue is actually Barrett's esophagus. I usually treat patients aggressively to heal the inflammation (with drugs like Prilosec, Nexium, Prevacid, Protonix, etc., given twice a day), then repeat the endoscopy to better understand what is going on and repeat biopsies. I am not sure what the dye study is, but suspect it may be endoscopic confocal microscopy.

Q : 11

My father has metastatic esophageal cancer. He is four years out and shows no signs of cancer other than the original site in his esophagus. He had the original site radiated about four years ago. Since then he has been on Erbitux, getting treatments every other week. Would he be a candidate for your cryoablation technique, to remove remaining cells?

Your father may be a candidate for cryoablation. The best candidates have no evidence of disease outside the esophagus by recent CT and/or PET. For a consultation at our center, call 410-328-8731 or 800-492-5538 (ask for the GI division).

Q : 12

My 96-year-old mother-in-law has esophageal cancer that has moved into the liver. Would photodynamic therapy be recommended? I tried to suggest this therapy for her, but the doctor was relentless and said chemo-radiation was the only option.

Photodynamic therapy is not commonly being used anymore due to side effects and need to stay out of direct sunlight. Treatment options to improve swallowing include esophageal stent and burning away the tumor with a laser or the equivalent. Radiation alone can also shrink the tumor with less side effects than combined chemo and radiation. You should consider seeing an oncologist to discuss chemotherapy, see a gastroenterologist to discuss stents or laser treatment, or come to our combined specialty clinic, where she could be evaluated by both a medical and radiation oncologist.

Q : 13

An endoscopy showed a "salmon pink tongue like area from 40cm to 41 cm" in my stomach. My gastroenterologist says it is Barrett's Esophagus. Is it possible to have that in one's stomach?

Sometimes it can be difficult to know exactly where the stomach starts and esophagus ends, which is needed to identify Barrett's esophagus. Usually we biopsy this area, and the biopsy will be very helpful in letting you and your doctor know if this is Barrett's esophagus or not.

Q : 14

About 3 years ago I was told I had Barrett's after I had an endoscopy to check for ulcers. How often should I go back for another exam to reduce my risk for cancer?

Thank you for your question. Current guidelines recommend a repeat endoscopy 1 year after the diagnosis of Barrett's, then every 3 years. At each endoscopy, biopsies (tissue samples) should be taken every 2 cm along the length of the Barrett's in all 4 quadrants around the esophagus. If any pre-cancer changes are found (dyplasia), more frequent endoscopy may be needed.

Q : 15

I have Barrett's. How much can be revealed with just an optical endoscopy (no biopsies)? If the patient is anti-coagulated, what is the likelihood of bleeding if the instrument touches the organs? I'm on Coumadin and am Factor V Leiden heterozygous. My last endoscopy noted some dysplasia and "focal features" indefinite for dysplasia.

With the newest high definition scopes, some but not all abnormalities can be seen without biopsy. If dysplasia was seen on the last endoscopy, generally biopsies need to be done, if possible. Endoscopy can be done on Coumadin without significant risk of bleeding, if necessary. The alternative is to use Lovenox injections when the Coumadin level (INR) falls, holding the Lovenox on the day of the procedure/biopsies. We do this commonly.

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