This book describes Barrett’s Esophagus, Diagnosis and Treatment and Related Diseases
Barrett’s Esophagus (BE) is a disorder in which the esophagus lining is injured by stomach acid.
Barrett’s Esophagus is described as an esophagus in which any segment of the normal distal squamous epithelial lining has been substituted by metaplastic columnar epithelium.
This is clearly seen endoscopically (>1 cm) above the gastro-esophageal junction and validated histopathologically from esophageal biopsies
People with BE have a higher risk for cancer in the area affected. Cancer is not frequent.
It is often subdivided into short-segment (less than 3 cm) or long-segment (more than 3 cm)
Barrett's esophagus occurs from chronic gastro-esophageal reflux.
The metaplastic columnar epithelium is at danger of rising stages of dysplasia resulting in invasive adenocarcinoma of the esophagus
The risk rises with longer period of time and raised frequency of gastro-esophageal symptoms.
Hiatus hernia is a danger factor and the size of the hernia is linked with the length of Barrett's esophagus
Some studies suggest a higher incidence of obesity, smoking and alcohol intake.
Risk factors for transformation to adenocarcinoma are:
3.Extended segment (>8 cm) disease,
5.Duration of reflux history,
6.Early age of onset of GERD,
8.Mucosal damage (ulceration and stricture) and
BE itself does not produce symptoms.
The acid reflux that produces Barrett’s Esophagus often results in symptoms of heartburn.
The patient may require an endoscopy if GERD symptoms are severe or come back after treatment.
During the endoscopy, the doctor may obtain tissue samples from different parts of the food pipe to help diagnose the disorder.
They also help look for tissue alterations that could result in cancer.
The diagnosis of Barrett’s Esophagus needs biopsy verification of specialized intestinal metaplasia (SIM) in the esophagus
When high-grade dysplasia or cancer is discovered on surveillance endoscopy, endoscopic ultrasonography (EUS) is advised to evaluate for surgical removal.
Treatment of GERD
The treatment should reduce acid reflux symptoms, and may keep BE from becoming worse.
The treatment may require lifestyle alterations and medicines such as:
1.Antacids after meals and at bedtime
2.Histamine H2 receptor blockers
3.Proton pump inhibitors
4.Avoiding alcohol and tobacco use
Lifestyle changes, medicines, and anti-reflux surgery may reduce symptoms of GERD.
Treatment of Barrett’s Esophagus
The doctor may advise surgery or other interventions to treat BE
Some of these procedures can eliminate the damaging tissue in the esophagus:
Photodynamic therapy (PDT) utilizes a special laser device, known as an esophageal balloon, together with a photosensitizer drug called Photofrin.
Other interventions utilize different types of high energy to damage the precancerous tissue.
Surgery to remove the abnormal lining
Esophageal cancers occurring in Barrett's esophagus determined by surveillance are often in the early stage and give an excellent prognosis.
When surveillance is regarded suitable, it should be done every 2-5 years, depending on the length of the involved segment and the presence of intestinal metaplasia.
The treatment of low-grade dysplasia is not obvious
It is advised that, after two pathologists have verified the diagnosis, surveillance endoscopy be done every six months.
High-grade dysplasia is linked with focusing on the presence of invasive adenocarcinoma in 30-40% of patients.
Esophagectomy is often done in severe dysplasia
TABLE OF CONTENT
Chapter 1 Barrett’s Esophagus
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Dysphagia
Chapter 8 Gastroesophageal Reflux Disease
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About the Author
Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor"