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Regional Digestive ConsultantsDr. Behara, MD, AGAFDr. Shailaja BeharaRDCRegional Digestive Consultants

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Esophageal Cancer Prevention

Am I at risk for Esophageal Cancer?

There are two main types of esophageal cancer: squamous cell cancer and adenocarcinoma of the esophagus.

Squamous cell cancer occurs most commonly in African Americans as well as people who smoke cigarettes and drink alcohol excessively. This type of cancer is not increasing in frequency.

The other cancer, adenocarcinoma of the esophagus, occurs most commonly in Caucasians as well as people gastroesophageal reflux disease (GERD). This cancer is increasing in frequency.

The most common symptom of GERD is heartburn, a condition that 20 percent of American adults experience at least twice a week. Although these individuals are at increased risk of developing esophageal cancer, vast majority of them will never develop it. But in a few patients with GERD (estimated at 10-15%), a change in the esophageal lining develops, a condition called Barrett’s esophagus. Most cases of adenocarcinoma of the esophagus begin in Barrett’s tissue.

Why you may need esophageal cancer screening?

Gastroesophageal reflux disease (GERD), commonly known as heartburn, can have serious repercussions if it is chronic and untreated. GERD can lead to a host of medical issues including difficult swallowing. Barrett’s esophagus (sometimes a pre-cancerous condition) ulcers and esophageal cancer. Esophageal cancer is the seventh leading cause of cancer death in the U.S patients with chronic reflux or other risk factors may need screening for Barrett’s esophagus with an upper endoscopy by a gastroenterologist for a full evaluation and treatment to rule out a more serious underlying condition.

If you suffer from frequent heartburn and have any of these other symptoms, make an appointment to see Dr. Shailaja Behara, for an evaluation:

  • Acid or bitter taste in mouth
  • Pain or discomfort in chest
  • Hoarseness (voice changes)
  • Chronic cough
  • Unexplained weight loss
  • Difficulty swallowing (dysphagia)

  • Nausea after eating
  • Regurgitation
  • Belching
  • Excessive clearing of throat
  • Recurrent sore throat

  • Who should be screened for Barrett’s esophagus?

    Barrett’s esophagus is twice as common in men as women. It tends to occur in middle-aged Caucasian men who have had heartburn for many years. There’s no agreement among experts on who should be screened. Even in patients with heartburn. Barrett’s esophagus is uncommon and esophageal cancer is very rare. One recommendation is to screen patients older than 50 who have had significant heartburn on required regular use of medications to control heartburn for several years. If that first screening is negative for Barrett’s tissue, there is no need to repeat it.

    What is dysplasia?

    Dysplasia is a precancerous condition that doctors can only diagnose by examining biopsy specimens under a microscope. Doctors subdivide the condition into high-grade, low-grade, or indefinite for dysplasia. If dysplasia is found on your biopsy, your doctor might recommend more frequent endoscopies, attempts to destroy the Barrett’s tissue, or esophageal surgery. Your doctor will recommend an option based on the degree of the dysplasia and your overall medical condition.

    How is Barrett’s esophagus treated?

    The goal of treatment in patients with Barrett's esophagus is to control reflux symptoms. Aggressive reflux treatment may be more effective in preventing cancer than treating only when there are reflux symptoms.

    Medicines and/or surgery can effectively control the symptoms of GERD. However, neither medications nor surgery can reverse the presence of Barrett’s esophagus or eliminate the risk of cancer.

    -GERD treatment: consists of using high-dose antacid oral medications, typically in the proton pump inhibitor family, such as omeprazole (Prilosec) or pantoprazole (protonix). Histamine blockers such as ranitidine (Zantac) would be an alternative.

    Lifestyle modifications are also strongly recommended for patients with Barrett’s esophagus. Avoiding caffeine, alcohol, carbonated beverages and tobacco use recommended. In addition, avoiding lying flat within four hours of a meal and elevating the head of the bed will reduce the changes or reflux.
    High-risk patients include those with very long segment of Barrett’s esophagus (more than 10 cm) and those h a strong family history of esophageal cancer.
    Ablation treatments include radiofrequency ablation (RFA) and/or cryotherapy in patients with BE and high-grade dysplasia.

    If I have Barrett’s esophagus, how often should I have an endoscopy to check for dysplasia?

    The risk esophageal cancer in patients with Barrett’s esophagus is quite low, approximately 0.5 percent per year 9or 1 out of 200). Therefore, the diagnosis of Barrett’s esophagus should not be a reason for alarm. It is, however, a reason for periodic endoscopies. If your initial biopsies don’t show dysplasia, endoscopy with biopsy should be repeated about every 2- 3 years. If your biopsy shows dysplasia, your doctor will make further recommendations.

    Evaluation for Esophageal cancer or Barrett’s esophagus screening

    The first step to prevention is to determine the current condition of your esophagus. To accomplish this, Dr. Behara will examine your esophagus for damage. One way to do this is through an upper endoscopy. The advantage of an upper endoscopy test is that it gives Dr. Behara the ability to collect biopsy or tissue sample.

    Upper endoscopy is a test that allows your doctor to see the inside of the esophagus and stomach. Before the test, you are sedated to prevent discomfort. The doctor will insert a thin lighted tube into the esophagus. The tube has a camera, which allows the doctor to see the lining of the esophagus. (see Procedures Performed -Upper endoscopy )

    Normally, the lining should appear pale and glossy; in a person with Barrett's esophagus, the lining appears pink or red and velvety. Although this examination is very accurate, your doctor will take biopsies as well as look for the precancerous change of dysplasia that cannot be seen with the endoscope only slightly lengthens the procedure time, causes no discomfort and rarely causes complications. Your doctor can usually tell you the results of your endoscopy after the procedure, but you will have to wait a few days for the biopsy results.

    There are currently No X ray studies or blood tests that can accurately diagnose Barrett’s esophagus. A combination of Upper GI endoscopy and Pathological review of biopsies remains the gold standard to identify this disease.

    What is Barrett’s esophagus(BE)?

    Barrett’s esophagus is a condition in which the esophageal lining changes, becoming similar to the tissue that lines the intestine. A complication of GERD, Barrett’s it is more likely to occur in patients who either experienced Gerd first at a young age or have had a longer duration of symptoms. The frequency and or severity of GERD does not affect the likelihood that Barrett’s may have formed. Dysplasia, a precancerous change in the tissue, can develop in any Barrett’s esophagus requires biopsy confirmation.

    What causes Barrett’s esophagus (BE)

    Risk factors associated with the development of Barrett’s esophagus include long-standing gastroesophageal reflux, male gender, Caucasian race, central obesity, smoking and over 50 years of age. The goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma, a malignancy that has been increasing in incidence since the 1970s.

    Approximately 10-15% of patients with GERD will have BE. However, some patients with BE may not have active reflux symptoms.

    BE is quite rare in children and is not considered to run in families or to have a significant genetic component at this time.

    Catching the disease early increases your chances of surviving the cancer exponentially. Early-stage cancer is treatable, but in the early stages, the cancer often shows no symptoms. Esophageal cancer prevention can save your life! Please contact our office if you have any questions or to schedule a consultation with the GI doctor, Dr. Shailaja Behara, by calling us at 281-528-1511.

    Important Reminder:

    This information is only intended to provide guidance, not definitive medical advice. Please consult a doctor about your specific condition. Only a trained, experienced physician such as Dr. Behara can determine an accurate diagnosis and proper treatment.

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