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Barrett's Esophagus and PPI Use

Upwards of twenty-six percent of the population in the Western world suffers from weekly acid reflux symptoms.

Mark Cedar Spartan ATE
Mark Cedar

These may include heartburn, regurgitation of food or gastric contents, trouble swallowing, nausea and even atypical symptoms such as cough, hoarseness, and the sensation of a lump in the throat.

Because of the prevalence of acid reflux, also known as gastroesophageal reflux disease (GERD), the majority of these patients eventually end up on proton pump inhibitor (PPI) medications such as Omeprazole (Prilosec) or Esomeprazole (Nexium). These popular medications have generated many eye-catching newspaper headlines over the past few years related to their potential side effects and interactions.

Before we discuss these medications and other treatment options we should first understand the possible dangers of having acid reflux, particularly if it remains untreated. Barrett's is a chronic condition in which the lining of the lower esophagus is replaced by specialized pre-cancerous cells. This condition produces no symptoms and is typically discovered during upper endoscopy (EGD). An EGD is an exam done by a gastroenterologist where a thin flexible lighted scope is inserted down the back of the throat into the esophagus, stomach and small intestine. Though we have found this disease in patients of all ages and race, Barrett's is twice as common in Caucasian men and the average age at diagnosis is 55 years. In our practice we have several patients in their 20's and 30's who carry this diagnosis. The major concern in patients who suffer from chronic reflux is esophageal cancer. Between 0.2 to 2% of patients per year with Barrett's esophagus will develop a specific cancer of the esophagus known as adenocarcinoma. Typically, our national gastroenterology organizations recommend a patient undergo an initial EGD in those who have weekly GERD symptoms that have been present for at least five years.

Once the diagnosis of Barrett's is made we educate our patients on following strict "anti-reflux precautions", which may include eliminating or decreasing caffeine, alcohol, nicotine, spicy foods and late-night snacking. All patients are started on a PPI and surveillance EGDs with biopsies of the abnormal tissue are repeated every one to three years. If advanced cells known as dysplasia are identified under the microscope then more invasive treatment options to destroy this tissue are performed such as radiofrequency ablation, cryotherapy or even surgical removal of the esophagus in advanced cases.

Since PPI therapy is now available over the counter and therefore used for problems that are often not acid-mediated, it seems that I end up stopping this medication in newly referred patients almost as often as I initiate it. However, long-term PPI therapy is essential for many patients, including those with Barrett's esophagus.

Our physicians at the South Hills Endoscopy Center are available to see new patients for all types of gastrointestinal, pancreas and liver problems including GERD and Barrett's esophagus. Primary care referrals for initial office consultations or endoscopic procedures are often unnecessary.





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