|
 |
 |
The esophagus is a muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. Its inner lining, or mucosa, normally consists of flat cells (known as squamous cells) which are similar to those of the skin. When this squamous cell lining is replaced by other cells that have a more cube-like shape, the condition is known as Barrett's esophagus or the columnar-lined esophagus, referring to cells that are shaped like a column. When Barrett's esophagus is present, the columnar lining extends from the junction of the esophagus and stomach upwards into the esophagus for a variable distance ranging from a few centimeters to nearly the entire length of the esophagus.
Many believe that the damage to the squamous mucosa which leads to the development of Barrett's esophagus is caused by chronic reflux of acid from the stomach into the esophagus. This damage may be aggravated by other substances that are also refluxed from the stomach into the esophagus, such as digestive enzymes from the pancreas and salts contained in bile. It is likely that some people are predisposed to develop Barrett's esophagus based on their genetic make-up.
There is no need for routine treatment for Barrett's esophagus. Most people who have Barrett's esophagus have heartburn or other symptoms of acid reflux and take antacids or some type of medication to suppress the production of stomach acid. These medications provide relief from reflux symptoms but don't have any important effects on the Barrett's mucosa. As far as we can tell, there is no easy way to cause the Barrett's mucosa to disappear, nor is there any easy way to prevent the development of cancer in a patient with Barrett's mucosa.
Whether dysplasia exists is difficult to determine except by an expert pathologist. Low-grade dysplasia requires no specific therapy. An increase in the frequency of surveillance endoscopy is usually recommended for patients with low-grade dysplasia because of the further increase in risk of degeneration into cancer.
If the presence of high-grade dysplasia is confirmed, the appropriate management is controversial. Some physicians will recommend close surveillance with endoscopy every 3 to 6 months. Mucosal destruction combined with intense acid suppression is being used experimentally to reduce the risk of cancer.
For most patients the appropriate recommendation is to have the esophagus removed. This is because in up to 50% of patients who have high-grade dysplasia identified on endoscopic biopsy the results of surgery actually show an unsuspected cancer. The results of surgical therapy for an esophageal cancer identified in this setting are quite good.
Dr Ninan performs ablation of Barrett’s esophagus with dyspasia in selected cases with methods such as photodynamic therapy and radiofrequency ablation. Cases of high grade dyspasia are ofen treated surgically, with the most minimally invasive surgical techniques. |
