Barrett’s and GERD

What is Barrett’s esophagus?Barrett’s esophagus is a condition where the normal cell lining (stratifiedsquamous epithelium) of the food pipe (the tube that connects the mouth to the stomach),or a segment of it, is replaced with a different tissue similar to the lining of the intestine.The transformation is called intestinal metaplasia. This occurrence is rare and affectsabout 1.6 to 3 percent of people. In rare instances and in some individuals, this becomesa pre-cancerous risk.Why is Barrett’s a concern?This condition, while mostly without symptoms and could only be an incidentalfinding and diagnosed during gastroscopy, is of extreme interest to patients who havethem and their physicians because Barrett’s poses a slightly increased risk for causing atype of cancer of the esophagus called adenocarcinoma, which could kill if not detected,treated, and followed up regularly. This rare cancer affects one-half percent of peoplewith Barrett’s.Are Barrett’s and GERD associated?Yes, GastroEsophageal Reflux Disease (GERD), where the one-way sphincter(valve) between the food pipe and the stomach has become incompetent (loose and wideopen), allowing acid and other gastric chemicals to back-up into the lower end of theesophagus, is linked to GERD. It increases the risk for the development of Barrett’s,because those chemicals normally produced by the stomach to aid in food digestion areirritants to the esophagus. This situation also raises the risk for chemical burns, scarring,narrowing, and cancer of the lower end of the esophagus which is connected to the

stomach. Unlike the stomach lining, the esophageal lining is not resistant (and is verysensitive) to acids and gastric juices.What causes Barrett’s esophagus?Like most diseases, certain groups of individuals are more prone to develop Barrett’sesophagus. GERD, as we have alluded to above, is linked to Barrett’s, with 5 to 10 percent of thosewith GERD developing Barrett’s.

The following are the risk factors: overweight, obesity, smokers,chronic GERD of more than 5 years, long-term GERD patient below 30 and over age 50 and
needing medications regularly. Those taking aspirin or other anti-inflammatory drugs and those withHelicobacter pylori infection of the stomach have higher predisposition to Barrett’s. Caucasian malesare more prone than other males. In general, males are twice more at risk than females, and so withthose whose diet is high in fruits and vegetables. In spite of all this, Barrett’s is still a rare disease.What is the prevalence of GERD?In North America, 18.1 to 27.8 percent; Europe, 8.8 to 28.9 percent; Middle East, 8.7 to 33.1percent; South America, 23 percent; Australia, 11.6 percent; Asia as a whole, 14 to16 percent; andthe Philippines, 11 to 15 percent. Clinical observations reveal an increasing prevalence of GERD,worldwide. Some patients with GERD have been found to have hiatal hernia.What does hiatal hernia do?

The food pipe, which is in the chest, goes down through a hole in the diaphram(the tent-like flat muscle that separates the abdomen from the chest) to connect with thestomach in the abdomen. This hole is called a hiatus. If this hole becomes too large, thestomach, which is normally in the abdomen, could move up to the chest through the hole.If this happens, it is called Hiatus Hernia, and this makes the esophagogastric sphincterloose, allowing gastric contents to back up to the stomach causing reflux esophagitis.Hiatus Hernia is found in only 20-30 percent of those with reflux esophagitis. Severecases of hiatal hernia will require surgery to reduce the size of the hole to normal andkeep the stomach in the abdomen.What are the symptoms of GERD?While Barrett’s is mostly asymptomatic, people with GERD usually has heartburn sensationat the pit of the stomach. Others have “chest” pains. Some have belching and sour eructation of food(back-up from stomach to esophagus and throat), especially when they lie down after a meal. Andmore especially if the meal is spicy hot and alcoholic beverage is consumed. Stomach and food pipefiberoptic “tele”scope with a lighted videocam (esophagogastroscopy) with tissue biopsy will clinchthe diagnosis for Barrett’s and GERD.

What are the complications of GERD?Besides the discomfort, patients with GERD are treated to prevent potential complications,which include erosion ulcers of the distal esophagus, bleeding, scarring, and constriction (causingswallowing difficulty), and, as stated above, cancer of the esophagus.What is the treatment?For Barrett’s, regular follow-up endoscopy and tissue biopsy is the routine, unless the biopsyshows the presence of cancer, in which case, surgery will be the treatment. GERD, which is a risk forBarrett’s, on the other hand, is aggressively treated with medications to reduce the acid secretion inthe stomach, with a class of drugs called proton pump inhibitors, like esomeprazole (Nexium),omeprazole (Prilosec) , lansoprazole (Prevacid) and pantoprazole (Protonix), etc. Lifestyle changeswill include normal weight maintenance, avoidance of tight clothing and of lying down immediately
after a meal, abstinence from smoking and avoidance of alcohol and spicy foods, elevation (6-8inches) of the head of the bed to reduce reflux of acids from the stomach to the esophagus, andfollow-up endoscopy.

The side effects of the acid reducer pills will also be managed. In cases ofsevere tissues changes, any of the following procedures may be used: Radiofrequency ablation,Cryotherapy, Photodynamic therapy, Endoscopic mucosal resection, and Esophagectomywhichever one is clinically indicated.What is low-acid GERD diet?Foodwise, the basic principle is to eat natural low-acid foods. Many fruits,vegetables and drinks (soft drinks and fruit juices) have high acidic contents. Some of thelow-acid foods include, fish (poached, grilled, baked, not fried), lean poultry (remove skin)and meats (baked, grilled, steamed, not fried), oat meal, brown rice, couscous, potatoes,bananas, water melons, cantaloupes, honeydew, broccoli, green beans, celery,cauliflower, asparagus, egg whites, skip the yolk (which will cause symptoms). As far asthe pH of food (measure of acidity, the lower the pH the more acidic) is concerned as aguide, choose foods with pH of 5 and higher to prevent symptoms. You may also Googlethe pH levels of various food items.Visit Email: [email protected]