If you suffer from chronic heartburn, you may actually have more serious condition called gastroesophageal reflux disease, or GERD, a very common disorder.
In GERD, there is chronic regurgitation of the stomach’s digestive “juices” into the esophagus.
This is unpleasant and also can cause substantial harm to the tissues of the esophagus, especially when the backflow is acidic.
If GERD is left undiagnosed and untreated, it can lead to a condition called Barrett's esophagus that may cause a rare cancer called esophageal adencarcinoma.
Find out more Barrett's esophagus from Summit Medical Group’s Dr. Raymond Kelly, a noted gastroenterologist, by tuning into SMG radio.
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Barrett’s Esophagus- What You Need To Know
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Learn more about Raymond P. Kenny, MD
Learn more about The Gastroenterology Group of New Jersey at SMG
Raymond Kenny, MD
Raymond P. Kenny, MD, is a gastroenterologist, a physician specializing in diseases of the digestive system. He is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including the Journal of Laparoendoscopic Surgery, and the medical publication Gastroenterology. Dr. Kenny is Clinical Assistant Professor in the Department of Medicine at Rutgers New Jersey Medical School.Learn more about Raymond P. Kenny, MD
Learn more about The Gastroenterology Group of New Jersey at SMG
Transcription:
Barrett’s Esophagus- What You Need To Know
Melanie Cole (Host): If you suffer from chronic heartburn you may actually have a more serious condition called Gastroesophageal Reflux Disease or GERD. If GERD is left undiagnosed and untreated, it can lead to a condition to Barrett’s Esophagus. My guest today is Dr. Raymond Kenny. He’s a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Kenny. Start with a little overview of GERD and how it can possibly lead to this condition called Barrett’s Esophagus.
Dr. Raymond Kenny (Guest): Well GERD or Gastroesophageal Reflux Disease is the retro grade movement of fluid from the stomach, which is acid in character, up into the esophagus. That can lead to, over time, inflammation of the esophagus and commonly we feel that it’s heartburn. When we look down with an endoscope we can see erosion or that it’s actually ulcerations in the distal esophagus. In some sub set of patients, over time, there’s actually almost a protective change in the lining of the esophagus from the normal type of lining which is very similar to our skin, or squamous mucosa, to the type of lining more like the lining in the stomach. When we look at it with an endoscope, the normal esophagus is sort of a pink color, a pale pink color, and the lining in the esophagus is an orange color. So, we can look in the bottom of the esophagus and protectively, there’s a change from that normal pink color to an orange color. When that extended up from the junction from the esophageal gastric junction for 3 centimeters, or a little over an inch, it was labeled by Dr. Barrett in the 1950’s as Barrett’s Esophagus. The reason he gave a special name for this is because those people who have that type of lining in their distal esophagus are 30 times—30 times--more likely to get esophageal cancer compared to the normal population.
Melanie: Wow. That’s a big increase in this risk for cancer. So, are there symptoms of Barrett’s Esophagus? How would someone even know if this is starting to develop?
Dr. Kenny: Are there symptoms of Barrett’s Esophagus? The answer is ‘yes’ and ‘no’. The most common symptom associated with it is heartburn. Sixty percent of those patients with Barrett’s Esophagus are going to have heartburn, a classic symptom that we all know about, a retrograde burning sensation in the chest area. Forty percent of them don’t have any symptoms. But, today we use the symptom of heartburn, the frequency of heartburn and medication for the heartburn as an index as to when we get to be more concerned about Barrett’s Esophagus.
Melanie: How often would someone, if they are concerned with Barrett’s Esophagus, have an endoscopy do you think?
Dr. Kenny: Well, an index endoscopy somewhere around age 50 should be sufficient, unless there’s family history of esophageal cancer or there are relatively frequent heartburn symptoms. Generally speaking, we are seeing this entity around age 50 but it can occur earlier, particularly in families that have a history of esophageal cancer. For some of that persistent heartburn symptom, we are talking about several times a week, which they are taking over the counter medications, it would be reasonable to do that, particularly in certain ethnicities. It’s most common in middle-aged white males. Since I fit that category, I don’t think that’s fair but if you get a middle-aged white make with frequent heartburn symptoms 13% of them will have this condition.
Melanie: How interesting that this is the subset, the group of people that are at a higher risk because usually it’s, I don’t know, women or certain populations. So, that’s very interesting. What do you do if you’ve diagnosed someone with Barrett’s Esophagus? Are there treatments? Because then, with this increased risk of cancer is there a way to help prevent that from happening?
Dr. Kenny: Well, classically, in the past, we’ve basically just treated the underlying Gastroesophageal Reflux Disease. It’s interesting that you ask. At this point, we can actually do something about Barrett’s Esophagus itself. In the past, you had to surgically remove that section, that orange section up to the normal esophagus but now we have a relatively non-invasive mechanism to actually go in there and burn that abnormal lining away. When you do that, what grows back in is the normal mucosa. So, therefore, reducing the risk of the development of cancer over time. That procedure is called “radio frequency ablation”.
Melanie: So, what about lifestyle modification: behaviors and things that you do that can help with this as its going?
Dr. Kenny: Basically, the treatments of Barrett’s would be the same for Gastroesophageal Reflux Disease. You would want to pursue a lean body mass through diet and exercise. You would not want to eat big meals. You want to eat smaller meals. You don’t want to eat within two hours of lying down. So, those are the lifestyle modification that you would have. If you’re at the point of Barrett’s Esophagus, there are some other things that you need to do. You need to be monitoring for the development of what we call “dysplasia”. It’s basically, think of it as a pap smear – checking the lining every two years to see if there are some changes in the lining of the esophagus that show that is that even more increased risk of having cancer develop in a short time frame; at which point, you would then treat it with the radio frequency ablation that we’d mentioned earlier.
Melanie: If you treat it with that radio frequency ablation, does it, then, have the opportunity to come back or is it pretty much gone in that spot?
Dr. Kenny: For the most part, once you finish this course of treatment, which may be 3 or 4 treatments, 3 or 4 endoscopies to get rid of it, it will remain normal for an extended period of time. We have studies that are out 5 and 10 years in some cases. There is a relapse rate of the material which we then treat and then ablate it again. But, it’s a relatively low number. It’s less than 20% within a short time frame, say 5 years, and through that whole period of time, you’ve reduced the risk of the development of cancer.
Melanie: Then, would someone stay on the proton pump inhibitors or whatever medication you’ve given them then for the next bunch of years?
Dr. Kenny: Oh, yes. They would. Basically, the mindset is that reflux disease causes Barrett’s Esophagus; Barrett’s Esophagus causes cancer. So, if we’re at the point of Barrett’s Esophagus with dysplasia which is pending cancer development we, basically, certainly, go back to the point where we’re very strict about maintaining acid reduction after we’ve removed the Barrett’s.
Melanie: So then, in just the last few minutes and, Dr. Kenny--and you are such a great guest. Thank you so much for being with us. Give us your best advice for GERD and, hopefully, not leading to Barrett’s Esophagus and why listeners should come to Summit Medical Group and see you for their care.
Dr. Kenny: For people with ordinary reflux disease, most of these things are a lifestyle modification. Not so much in the things that we’ve talked about before of diet change in the sense of not having spearmint, peppermint and caffeine in their diet but reducing their weight. That’s probably the most important factor that’s correlated, not only with reflux disease, but with the development of Barrett’s Esophagus. Those are the most important things that they can do to prevent the problem. Once they have the problem and they’ve had a significant amount of reflux disease, we do need to treat it, particularly if they have erosive esophagitis and Barrett’s Esophagus. The point of having Barrett’s Esophagus, we’re at a tipping point in how we treat this and the aggressiveness with which we approach this. There is a subtle difference. In the past, we’ve done this surveillance where we look every two years to see if there’s a change in the development of dysplasia and we’re changing the philosophy now that we have a relatively non-invasive way of removing the Barrett’s Esophagus. There are doctors among us who are advocates of removing the Barrett’s Esophagus. One could make the analogy to colonoscopy. Would your doctor go in and do a colonoscopy, see a polyp which is considered a pre-cancerous condition and then leave it there only to come back in two years to go back and to see if it has yet to turn into cancer? No. He would remove the polyp. So, if he had the ability to remove the pre-cancerous condition, why wouldn’t he do that? Now, that’s somewhat of a false analogy in that one out of six polyps becomes cancer and it’s really thought that 96% of people with Barrett’s don’t develop cancer. So, the frequency of cancer development in those people is less. So, it’s somewhat of a false analogy but, basically, in those people where you can see that they have long segments of Barrett’s, which is a higher risk or there’s a family history of esophageal cancer, you might, in that case, make a very good argument for removing the Barrett’s altogether with the radio frequency ablation. So, those subtleties, those are things that experience tells us and time has told us what we should be doing with these patients. The vast majority of people with reflux disease don’t have these issues but in those people who do have these issues, I think a careful examination of the esophagus and some discussion with the patient about patient options is in order. Those are the things that we provide in our group and I’m very happy to discuss the expertise of the group in general. It’s a very well trained group in its entirety.
Melanie: Thank you so much. You are obviously an excellent physician. Thank you for being with us. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
Barrett’s Esophagus- What You Need To Know
Melanie Cole (Host): If you suffer from chronic heartburn you may actually have a more serious condition called Gastroesophageal Reflux Disease or GERD. If GERD is left undiagnosed and untreated, it can lead to a condition to Barrett’s Esophagus. My guest today is Dr. Raymond Kenny. He’s a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Kenny. Start with a little overview of GERD and how it can possibly lead to this condition called Barrett’s Esophagus.
Dr. Raymond Kenny (Guest): Well GERD or Gastroesophageal Reflux Disease is the retro grade movement of fluid from the stomach, which is acid in character, up into the esophagus. That can lead to, over time, inflammation of the esophagus and commonly we feel that it’s heartburn. When we look down with an endoscope we can see erosion or that it’s actually ulcerations in the distal esophagus. In some sub set of patients, over time, there’s actually almost a protective change in the lining of the esophagus from the normal type of lining which is very similar to our skin, or squamous mucosa, to the type of lining more like the lining in the stomach. When we look at it with an endoscope, the normal esophagus is sort of a pink color, a pale pink color, and the lining in the esophagus is an orange color. So, we can look in the bottom of the esophagus and protectively, there’s a change from that normal pink color to an orange color. When that extended up from the junction from the esophageal gastric junction for 3 centimeters, or a little over an inch, it was labeled by Dr. Barrett in the 1950’s as Barrett’s Esophagus. The reason he gave a special name for this is because those people who have that type of lining in their distal esophagus are 30 times—30 times--more likely to get esophageal cancer compared to the normal population.
Melanie: Wow. That’s a big increase in this risk for cancer. So, are there symptoms of Barrett’s Esophagus? How would someone even know if this is starting to develop?
Dr. Kenny: Are there symptoms of Barrett’s Esophagus? The answer is ‘yes’ and ‘no’. The most common symptom associated with it is heartburn. Sixty percent of those patients with Barrett’s Esophagus are going to have heartburn, a classic symptom that we all know about, a retrograde burning sensation in the chest area. Forty percent of them don’t have any symptoms. But, today we use the symptom of heartburn, the frequency of heartburn and medication for the heartburn as an index as to when we get to be more concerned about Barrett’s Esophagus.
Melanie: How often would someone, if they are concerned with Barrett’s Esophagus, have an endoscopy do you think?
Dr. Kenny: Well, an index endoscopy somewhere around age 50 should be sufficient, unless there’s family history of esophageal cancer or there are relatively frequent heartburn symptoms. Generally speaking, we are seeing this entity around age 50 but it can occur earlier, particularly in families that have a history of esophageal cancer. For some of that persistent heartburn symptom, we are talking about several times a week, which they are taking over the counter medications, it would be reasonable to do that, particularly in certain ethnicities. It’s most common in middle-aged white males. Since I fit that category, I don’t think that’s fair but if you get a middle-aged white make with frequent heartburn symptoms 13% of them will have this condition.
Melanie: How interesting that this is the subset, the group of people that are at a higher risk because usually it’s, I don’t know, women or certain populations. So, that’s very interesting. What do you do if you’ve diagnosed someone with Barrett’s Esophagus? Are there treatments? Because then, with this increased risk of cancer is there a way to help prevent that from happening?
Dr. Kenny: Well, classically, in the past, we’ve basically just treated the underlying Gastroesophageal Reflux Disease. It’s interesting that you ask. At this point, we can actually do something about Barrett’s Esophagus itself. In the past, you had to surgically remove that section, that orange section up to the normal esophagus but now we have a relatively non-invasive mechanism to actually go in there and burn that abnormal lining away. When you do that, what grows back in is the normal mucosa. So, therefore, reducing the risk of the development of cancer over time. That procedure is called “radio frequency ablation”.
Melanie: So, what about lifestyle modification: behaviors and things that you do that can help with this as its going?
Dr. Kenny: Basically, the treatments of Barrett’s would be the same for Gastroesophageal Reflux Disease. You would want to pursue a lean body mass through diet and exercise. You would not want to eat big meals. You want to eat smaller meals. You don’t want to eat within two hours of lying down. So, those are the lifestyle modification that you would have. If you’re at the point of Barrett’s Esophagus, there are some other things that you need to do. You need to be monitoring for the development of what we call “dysplasia”. It’s basically, think of it as a pap smear – checking the lining every two years to see if there are some changes in the lining of the esophagus that show that is that even more increased risk of having cancer develop in a short time frame; at which point, you would then treat it with the radio frequency ablation that we’d mentioned earlier.
Melanie: If you treat it with that radio frequency ablation, does it, then, have the opportunity to come back or is it pretty much gone in that spot?
Dr. Kenny: For the most part, once you finish this course of treatment, which may be 3 or 4 treatments, 3 or 4 endoscopies to get rid of it, it will remain normal for an extended period of time. We have studies that are out 5 and 10 years in some cases. There is a relapse rate of the material which we then treat and then ablate it again. But, it’s a relatively low number. It’s less than 20% within a short time frame, say 5 years, and through that whole period of time, you’ve reduced the risk of the development of cancer.
Melanie: Then, would someone stay on the proton pump inhibitors or whatever medication you’ve given them then for the next bunch of years?
Dr. Kenny: Oh, yes. They would. Basically, the mindset is that reflux disease causes Barrett’s Esophagus; Barrett’s Esophagus causes cancer. So, if we’re at the point of Barrett’s Esophagus with dysplasia which is pending cancer development we, basically, certainly, go back to the point where we’re very strict about maintaining acid reduction after we’ve removed the Barrett’s.
Melanie: So then, in just the last few minutes and, Dr. Kenny--and you are such a great guest. Thank you so much for being with us. Give us your best advice for GERD and, hopefully, not leading to Barrett’s Esophagus and why listeners should come to Summit Medical Group and see you for their care.
Dr. Kenny: For people with ordinary reflux disease, most of these things are a lifestyle modification. Not so much in the things that we’ve talked about before of diet change in the sense of not having spearmint, peppermint and caffeine in their diet but reducing their weight. That’s probably the most important factor that’s correlated, not only with reflux disease, but with the development of Barrett’s Esophagus. Those are the most important things that they can do to prevent the problem. Once they have the problem and they’ve had a significant amount of reflux disease, we do need to treat it, particularly if they have erosive esophagitis and Barrett’s Esophagus. The point of having Barrett’s Esophagus, we’re at a tipping point in how we treat this and the aggressiveness with which we approach this. There is a subtle difference. In the past, we’ve done this surveillance where we look every two years to see if there’s a change in the development of dysplasia and we’re changing the philosophy now that we have a relatively non-invasive way of removing the Barrett’s Esophagus. There are doctors among us who are advocates of removing the Barrett’s Esophagus. One could make the analogy to colonoscopy. Would your doctor go in and do a colonoscopy, see a polyp which is considered a pre-cancerous condition and then leave it there only to come back in two years to go back and to see if it has yet to turn into cancer? No. He would remove the polyp. So, if he had the ability to remove the pre-cancerous condition, why wouldn’t he do that? Now, that’s somewhat of a false analogy in that one out of six polyps becomes cancer and it’s really thought that 96% of people with Barrett’s don’t develop cancer. So, the frequency of cancer development in those people is less. So, it’s somewhat of a false analogy but, basically, in those people where you can see that they have long segments of Barrett’s, which is a higher risk or there’s a family history of esophageal cancer, you might, in that case, make a very good argument for removing the Barrett’s altogether with the radio frequency ablation. So, those subtleties, those are things that experience tells us and time has told us what we should be doing with these patients. The vast majority of people with reflux disease don’t have these issues but in those people who do have these issues, I think a careful examination of the esophagus and some discussion with the patient about patient options is in order. Those are the things that we provide in our group and I’m very happy to discuss the expertise of the group in general. It’s a very well trained group in its entirety.
Melanie: Thank you so much. You are obviously an excellent physician. Thank you for being with us. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.