By Shelagh McNally for Reflux1If left untreated, acid reflux can develop into an undetected disease of the esophagus that sometimes turns cancerous.
Barrett’s esophagus is a condition where abnormal cells develop on the inner lining of the esophagus (the muscular tube carrying food from the mouth to the stomach).
Approximately 10% of people with chronic acid reflux will develop Barrett’s esophagus with a risk of the condition turning cancerous. Those more susceptible include patients who have suffered from severe reflux for many years and people over 50.
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Treatments for Barrett’s Esophagus: Medication: The typical medications used are lansoprazole, omeprazole and pantoprazole are also effective at eliminating symptoms of reflux.
Endoscopic therapy: microsurgery can remove the dysplasia or carcinoma if found and limit the chances of developing cancer.
Surgery: This is usually performed only if the medications aren’t working. Doctors will recommend that esophagus needs to be surgically removed.
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The problem starts with the shape of cells. Normally, the cells lining the stomach are flat squamous cells. Patients with Barrett’s have rectangular-shaped cells in their lining, which can become pre-cancerous, a condition known as dysplasia. Dysplasia can be either low-grade or high-grade, depending on the severity of change. If feft untreated, these pre-cancerous cells can develop into esophageal adenocarcinoma—cancer of the esophagus.
Unfortunately, the condition often goes undetected because Barrett’s is so difficult to diagnose. Symptoms are similar to reflux and can often be masked or suppressed with over the counter medication. Many times, there are no symptoms present until the cancer is discovered. Once diagnosed, Barrett’s esophagus needs to be monitored every two to three years and can require a biopsy to examine the affected cells.
Due to the rising rates of esophageal adenocarcinoma, the medical community is examining how to do a better job diagnosing the disease and creating treatment strategies. Researchers from the Hutchinson-MRC Research Centre in Cambridge published their recommendations for dealing with the diagnosis problem in the inaugural issue of Disease Models & Mechanisms (DMM).
Currently there are only a few ways to diagnose the condition, all of which are intrusive. Doctors may order an endoscopy; a procedure that involves a thin tube with a camera is put down into the esophagus to check the lining. Diagnosis can also be determined by measuring the acid levels of the esophagus with 24-hour ambulatory pH monitoring. This involves a small recorder connected to a wire thin which is threaded through the nose into the esophagus where it records the acid level. However, the only way to truly confirm the condition is to do an endoscopic biopsy to remove a small tag of tissue which is examined for any cellular changes.
All three tests can be costly and painful and as a result, the examinations are not usually carried out leaving the condition undetected.
The Hutchinson-MRC researchers proposed introducing standardized indicators that can be used not only to indentify the condition, but also predict the likelihood of it progressing into cancer. Their final recommendation was a call for more research to study the underlying mechanisms of the cells that become cancerous and to test potential novel therapies.
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