Bar­rett's oe­soph­a­gus

Costa Blanca News (South Edition) - - Health -

Dr. Camp­man In Bar­rett's oe­soph­a­gus the cells that line the lower gul­let (oe­soph­a­gus) are ab­nor­mal. The main cause is long-stand­ing re­flux of acid from the stom­ach into the oe­soph­a­gus. Peo­ple with Bar­rett's oe­soph­a­gus have an in­creased risk of de­vel­op­ing cancer of the oe­soph­a­gus. The risk is small. How­ever, you may be ad­vised to have reg­u­lar en­do­scopies to de­tect pre­can­cer­ous changes to the cells in the oe­soph­a­gus. If pre­can­cer­ous changes de­velop then treat­ment to re­move or de­stroy the pre­can­cer­ous cells may be ad­vised. Un­der­stand­ing the oe­soph­a­gus

and stom­ach When we eat, food passes down the oe­soph­a­gus into the stom­ach. Cells in the lin­ing of the stom­ach make acid and other chem­i­cals which help to di­gest food. Stom­ach cells also make a thick liq­uid (mu­cus) which pro­tects them from dam­age caused by the acid. The cells on the in­side lin­ing of the oe­soph­a­gus are dif­fer­ent and have lit­tle pro­tec­tion from acid.

There is a cir­cu­lar band of mus­cle (a sphinc­ter) at the junc­tion between the oe­soph­a­gus and stom­ach. This re­laxes to al­low food down but nor­mally tight­ens up and stops food and acid leak­ing back up (re­flux­ing) into the oe­soph­a­gus. So, the sphinc­ter acts like a valve. What is Bar­rett's oe­soph­a­gus? Bar­rett's oe­soph­a­gus is a con­di­tion which af­fects the lower oe­soph­a­gus. It is named af­ter the doctor who first de­scribed it.

In Bar­rett's oe­soph­a­gus, the cells that line the af­fected area of oe­soph­a­gus be­come changed.

The cells of the in­ner lin­ing (ep­ithe­lium) of a nor­mal oe­soph­a­gus are pink­ish-white, flat cells (squa­mous cells). The cells of the in­ner lin­ing of the area af­fected by Bar­rett's oe­soph­a­gus are tall, red cells (colum­nar cells). The colum­nar cells are sim­i­lar to the cells that line the stom­ach. What causes Bar­rett's oe­soph­a­gus and how com­mon is it? The cause in most cases is thought to be due to long-term re­flux of acid into the oe­soph­a­gus from the stom­ach. The acid ir­ri­tates the lin­ing of the lower oe­soph­a­gus and causes in­flam­ma­tion (oe­sophagi­tis). With per­sis­tent re­flux, even­tu­ally the lin­ing (ep­ithe­lial) cells change to those de­scribed above.

It is thought that about 1 in 20 peo­ple who have re­cur­ring acid re­flux even­tu­ally de­velop Bar­rett's oe­soph­a­gus. The risk is mainly in peo­ple who have had se­vere acid re­flux for many years. How­ever, some peo­ple who have had fairly mild symp­toms of re­flux for years can de­velop Bar­rett's oe­soph­a­gus.

Bar­rett's oe­soph­a­gus seems to be more com­mon in men than in women. It typ­i­cally af­fects peo­ple between the ages of 50 and 70 years. Other risk fac­tors for Bar­rett's oe­soph­a­gus that have been sug­gested in­clude smok­ing and be­ing over­weight (par­tic­u­larly if you carry ex­cess weight around your mid­dle). You are also more likely to de­velop Bar­rett's oe­soph­a­gus if some­one else in your fam­ily al­ready has the con­di­tion. What are the symp­toms of acid re­flux and in­flam­ma­tion of the

oe­sophagi­tis? Heart­burn is the main symp­tom. It is a burn­ing feel­ing that rises from the up­per ab­domen or lower chest up to­wards the neck. (It is con­fus­ing, as it has noth­ing to do with the heart.) Other com­mon symp­toms in­clude: Feel­ing sick (nau­se­ated). An acid taste in the mouth. Bloat­ing. Belch­ing. A burn­ing pain when you swal­low hot drinks.

Like heart­burn, these symp­toms tend to come and go and tend to be worse af­ter a meal. Peo­ple with Bar­rett's oe­soph­a­gus will usu­ally have (or will have had in the past) the symp­toms as­so­ci­ated with acid re­flux and oe­sophagi­tis. What causes acid re­flux and

who is af­fected by it? The cir­cu­lar band of mus­cle at the bot­tom of the oe­soph­a­gus is called the sphinc­ter. It nor­mally pre­vents acid re­flux. Prob­lems oc­cur if the sphinc­ter does not work very well. This is com­mon but in most cases it is not known why it does not work so well. How­ever, hav­ing a hia­tus her­nia makes you more prone to re­flux. A hia­tus her­nia oc­curs when part of your stom­ach pro­trudes through the lower chest mus­cle (di­aphragm) into the lower chest

Most peo­ple have heart­burn at some time, per­haps af­ter a large meal. How­ever, about 1 in 3 adults have some heart­burn every few days, and nearly 1 in 10 adults have heart­burn at least once a day. In many cases it is mild and soon passes. How­ever, it is quite com­mon for symp­toms to be fre­quent or se­vere enough to af­fect qual­ity of life. It is peo­ple who have se­vere and long-stand­ing re­flux who are more likely to de­velop Bar­rett's oe­soph­a­gus. How is Bar­rett's oe­soph­a­gus

di­ag­nosed? Gas­troscopy (en­doscopy) - if you have se­vere or per­sis­tent symp­toms of acid re­flux. For this test, a thin, flex­i­ble tele­scope is passed down the gul­let (oe­soph­a­gus) into the stom­ach. This al­lows a doctor to look in­side. This test can usu­ally help to di­ag­nose Bar­rett's oe­soph­a­gus. The change in colour of the lin­ing of the lower oe­soph­a­gus from its nor­mal pale white to a red colour strongly sug­gests that Bar­rett's oe­soph­a­gus has de­vel­oped.

A biopsy – usu­ally taken at the same time as the gas­troscopy if ab­nor­mal­i­ties are seen. These are sent to the lab­o­ra­tory to be looked at un­der the mi­cro­scope. The char­ac­ter­is­tic colum­nar cells which are de­scribed above con­firm the di­ag­no­sis. The cells are also ex­am­ined to see if they have any signs of dys­pla­sia. What is the treat­ment for

Bar­rett's oe­soph­a­gus? Treat­ment of acid re­flux You are likely to be ad­vised to take acid-sup­press­ing med­i­ca­tion for the rest of your life. It is un­clear as to whether treat­ing the acid re­flux helps to treat or re­verse your Bar­rett's oe­soph­a­gus and more stud­ies are on­go­ing. How­ever, this treat­ment should help any symp­toms that you may have. Mon­i­tor­ing When you have been di­ag­nosed with Bar­rett's oe­soph­a­gus, you may be ad­vised to have a gas­troscopy and biopsy at reg­u­lar in­ter­vals to mon­i­tor the con­di­tion. This is called surveil­lance. The biopsy sam­ples aim to de­tect whether dys­pla­sia has de­vel­oped in the cells, in par­tic­u­lar if high-grade dys­pla­sia has de­vel­oped.

The ex­act time pe­riod between each gas­troscopy and biopsy sam­ple can vary from per­son to per­son. It may be every 2-3 years if there are no dys­pla­sia cells de­tected. Once dys­pla­sia cells are found, the check may be ad­vised every 3-6 months or so. If high-grade dys­pla­sia de­vel­ops, you may be of­fered treat­ment to re­move the af­fected cells from the oe­soph­a­gus

Surgery may be con­sid­ered. This is quite ma­jor surgery and if re­quired will be fully ex­plained to you by your Dr. Newer treat­ments There are now var­i­ous ways of re­mov­ing just the ab­nor­mal cells from the lin­ing of the oe­soph­a­gus. These in­clude the fol­low­ing:

Pho­to­dy­namic ther­apy (PDT): this is a type of laser treat­ment.

Ep­ithe­lial ra­diofre­quency ab­la­tion (EFA): this treat­ment uses a ra­diofre­quency en­ergy coil. The coil then emits heat en­ergy which de­stroys the ab­nor­mal cells. Nearby nor­mal cells then mul­ti­ply and re­place the de­stroyed ab­nor­mal cells.

Ar­gon plasma co­ag­u­la­tion: this treat­ment uses a jet of ar­gon gas, to­gether with an elec­tric cur­rent, to burn away dys­plas­tic cells.

En­do­scopic mu­cosal re­sec­tion (EMR): this is a pro­ce­dure that is done via in­stru­ments passed down the side of a gas­tro­scope.

If you are di­ag­nosed with Bar­rett's oe­soph­a­gus, your spe­cial­ist should be able to give you up-to-date in­for­ma­tion on which treat­ment is best for you. Send your med­i­cal queries or prob­lems to: ic­moraira@hot­ or see ad­vert be­low

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