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 15.

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Q : 1 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 : 2 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 : 3 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 : 4 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 : 5 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 : 6 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 : 7 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 : 8 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 : 9 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.
Q : 10 12/05/2008	At what point in Barrett's Esophogus should a patient choose surgery or other invasive treatment? Treatment for Barrett's is usually needed for high-grade dysplasia or early cancer. Treatment choices are surgery (esophagectomy) or endoscopic treatment (ablation). These treatments are best done at centers that see a significant number of patients each year (either surgery or ablation), usually a major medical center. We specialize in these treatments and can evaluate your condition if you are interested.
Q : 11 11/19/2008	Do you perform Cryotherapy on esophageal cancer patients who have been treated with radiation and chemotherapy but who are NOT able to undergo the surgery to remove the tumor? My Mom has a small tumor (T2 or 3) at the bottom of her esophagus and it is also in the lining but has not spread anywhere else. She had radiation and chemo and will be getting a PET scan and another scope soon to see if the tumor has shrunk and if the treatment worked at all. My fear is that even if the tumor shrank, it will grow back and she cannot endure the surgery to remove it. This is an area of great interest to me, since many patients are in your mother's situation. We have performed cryotherapy in this situation when PET scan shows no spread of the cancer outside of the esophagus. We do not have long-term follow-up, and success is variable. We can shrink the cancer with cryotherapy, even after radiation and chemotherapy. In some cases, we have been successful in destroying the tumor completely. Before treating with cryotherapy, we would perform an assessment to make sure this is appropriate. I am happy to discuss this further after the PET scan and scope. My office can be reached at 410 328-5780.
Q : 12 10/31/2008	I have recently been diagnosed with Barrett's esophagus. I have been on prilosec since the drug first came out, so at least 10-15 years I guess. My doctor says to watch and wait and re-do endoscopy every 2-3 years. My concern is this: my grandmother died in her early 60's and my younger brother died at 45, both from esophageal cancer. Thus it appears to run in my family, although my doctor says that it really isn't genetic. I am concerned that I should be being more proactive with this disease than my doctor seems to feel is needed. Do you or can you use this cryotherapy procedure to prevent Barrett's from getting worse or becoming cancerous? There is no one around here that does this procedure as far as I can tell. I appreciate your concern about your Barrett's esophagus. You raise several important questions. 1. Genetics of Barrett's esophagus - several sites are conducting family studies to investigate whether there is a familial component to Barrett's esophagus. These include the Cleveland Clinic in Cleveland and Mayo Clinic in Rochester. They are still in the data collection stage, so we don't have good information yet, but stay tuned. 2. Follow-up - recent guidelines on the management of Barrett's esophagus have been published in the American Journal of Gastroenterology. They recommend the course proposed by your doctor - endoscopy every 2-3 years. It is important that biopsies of the esophagus be obtained in 4 quadrants every 2 cm within the length of the Barrett's tissue (so if your Barrett's segment is 4 cm long, at least 8 biopsies would be obtained). 3. Getting rid of Barrett's - the state of the art in 2008 is to perform ablation (removal of all Barrett's tissue) only in those patients who have dysplasia in their Barrett's segment. This recommendation is based on the low risk of cancer if dysplasia is not present, lack of long-term data on ablation in this setting, and inability to remove all of the Barrett's tissue in some patients. This recommendation may change over time as we learn more about ablation techniques and risk of cancer in certain groups (like those with family members with cancer). You may consider getting a second opinion about Barrett's esophagus from a gastroenterologist associated with a medical school/teaching hospital for more specific recommendations. I hope this helps answer some of your questions.
Q : 13 10/28/2008	My 66 year old mother was recently diagnosed with level 2B esophagus cancer which as gone through the muscle and fat but not the lymph nodes. Do you think this maybe a possible option for her to consider if cancer isn't anywhere else in her body? I am sorry to hear about the diagnosis in your mother. Cryospray ablation appears to be effective for treating stage I cancer, which has not spread beyond the superficial layers of the esophagus. Unfortunately, it can not treat into the deeper esophageal layers or affect cancer that has spread into lymph nodes. Based on this, I don't think cryospray is an option for your mother.
Q : 14 10/26/2008	A friend experiencing problems swallowing his food was recently diagnosed as having cancer in his esophegus. I've read that in a person having such problems, the cancer is usually in an advanced stage. They are about to undergo 1 or 2 rounds of pre-emptive chemo and then go through the surgery. Is someone at this stage a candidate for CSA? TI am sorry to hear about the diagnosis in your friend. Judging by the therapy you describe, I suspect your friend has stage 2 or stage 3 cancer. Unfortunately, cryospray can treat only the superficial layers of the esophagus, and can not penetrate deep enough to treat the entire cancer (including lymph nodes) for stage 2/3 cancers.
Q : 15 10/18/2008	My father(age 68) has recently been diagnosed with stage 3 esophageal cancer caused by Barrett's. However, the cancer has spread to the surrounding lymph nodes and windpipe. He has not started chemo or radiation yet. Do you think he would be a candidate for this type of treatment (cryospray)? Thank you for allowing me to comment on your father's care. Esophageal cancer is commonly detected at stage 3, with spread to surrounding lymph nodes. At this stage, chemotherapy and radiation are generally the correct treatment. Esophageal cryoablation (cryospray) is best utilized when treating early esophageal cancer or precancerous changes in the esophagus, where this no spread beyond the wall of the esophagus. Once an esophageal cancer has spread beyond the esophagus, cryoablation may shrink part of the cancer but has no effect on the lymph nodes.

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