Health Chats
Barrett’s Esophagus and GERD
Tuesday Aug 25, 2009, 12:00PM - 01:00PM (EST)
Gary W Falk, MDBlank
Cleveland Clinic
, Cleveland, OH
The Cleveland Clinic Digestive Disease Institute has been ranked second in the nation by U.S. News & World Report’s Best Hospitals Survey since 2003, and first in Ohio since 1990. <br><br> Cleveland Clinic Digestive Disease Institute (DDI) is the first of its kind to unite all specialists within one unique, fully integrated model of care - aimed at optimizing patient experience. At DDI we offer patients the most advanced, safest and proven medical and surgical treatments primarily focused on the gastrointestinal tract. Our departments include: <ul> <li>Gastroenterology & Hepatology <li>Colorectal Surgery <li>Hepato-pancreto-biliary and Transplant Surgery <li>Center for Human Nutrition </ul> Gary W. Falk, MD is currently a Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He is also Director of the Center for Esophageal and Swallowing Disorders and has previously been Director of the GI Fellowship Training Program at Cleveland Clinic. He is currently an Associate Editor of the American Journal of Gastroenterology and a contributor to the Selected Summaries section of Gastroenterology. He is past President of the American Society for Gastrointestinal Endoscopy.<br><br> The focus of this Health Chat will be on Gastroesophageal Reflux Disease (GERD) and Barrett’s Esophagus.<br><br> <b>GERD</b> is also known as Acid Reflux, Gastric Reflux and Heartburn. GERD is a burning sensation in the center of the chest that often occurs after eating, bending over, with exercise, and sometimes at night when lying down. Approximately one in 10 adults has heartburn at least once a week and one in three monthly. Some pregnant women experience heartburn almost daily as a result of increased pressure on the abdomen and hormonal changes. Although its name implies otherwise, heartburn has nothing to do with your heart. Rather, these symptoms indicate a condition called gastroesophageal reflux disease, or GERD. <br><br> <b>Barrett's esophagus</b> is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. There are a number of risk factors for the development of Barrett's esophagus. Patients at greatest risk of developing Barrett's are Caucasian males over age 50 who have a history of chronic heartburn. <form name="signup_form2" method="post" action="/health_chats/register/16"><br/> <div class="actions float_fix"> <a onclick="return false;" id="signup_form2_submit" class="big_gr_btn" href="#"><img src="/RoR/images/blank.gif" class="btn_l_img pos_rel"/><span style="padding-top: 2px;" class="btn_r_txt pos_rel"><span class="btn_r_txt_w">Register</span></span></a> <span><input type="submit" value="signup_form_h_submit" name="commit" class="hidden_submit"/></span> <script> Event.observe(document.signup_form2, 'submit', function(e) { if (true) { $('signup_form2_submit').replace('<b>Submitting</b> <img src="/RoR/images/wait_arrows.gif">'); } else { Event.stop(e); } } ); Event.observe($('signup_form2_submit'), 'click', function(e) { if (true) { document.signup_form2.submit();$('signup_form2_submit').replace('<b>Submitting</b> <img src="/RoR/images/wait_arrows.gif">'); } }); </script> </div> </form> <br/>
MedHelp:
Hi, the health chat will be starting shortly, at 12 EST. In the meantime, if you'd like to submit a question, please do. Thank you
kaysus:
I have been diagnosed with Barrett's Esophagus.  How often should I have my stomach scoped to monitor it to make sure that it doesn't turn into cancer?  Thanks -  Kayleen
MedHelp:
MedHelp is very pleased to welcome Dr. Gary Falk to our Health Chat today.  Dr. Falk is the Director of the Center for Esophageal and Swallowing Disorders at the Cleveland Clinic in Cleveland OH.  He is here to answer your questions about GERD and Barrett’s Esophagus.  Welcome Dr. Falk!
Gary W Falk, MD:
If you have a confirmed diagnosis of Barrett's esophagus without dysplasia, you should have a second endoscopy in 1 year and if that is negative every 3 years.  This requires guideline based systematic biopsies and expert pathology review.  Surveillance more frequently cannot be justified if there is no dysplasia.  Dysplasia is a different story however.  
Jack615:
I live in Chagrin Falls, OH.  Does the Cleveland Clinic have any clinical trials for patients with Barrett's Esophagus? How would I go about registering for one of these clinical trials?
Gary W Falk, MD:
We have clinical trials looking at endomicroscopy, chemoprevention, inherited risk and other areas just to name a few.  My coordinator can be reached at 216-445-0953 to see what study would be of most interest to you.  
monotreme:
My husband has Multiple Sclerosis and was diagnosed with Barrett's Esophagus in Fall 2008.  He was put on Prilosec one pill twice a day.  Are there any dietary recommendations you could make to help prevent the Barrett's to becoming cancerous?
Gary W Falk, MD:
Please remember that most people with Barrett's will never develop cancer.  Risk factors are obesity, a diet low in fruits and vegetables, uncontrolled reflux and smoking.  There are no known diets to prevent cancer but a prudent diet high in fresh fruits and vegetables is a good idea.
Sandy M:
How often should I have an endoscopy for Barrett's Esophagus and how  important is the interpretation of my biopsies?
Gary W Falk, MD:
Expert pathology review is absolutely crucial.  For example here at the Cleveland Clinic we have a group of pathologists who just look at gastrointestinal pathology, nothing else!  Intervals are every 3 years after 2 in a row within 1 year are negative for dysplasia.  Dysplasia requires more frequent surveillance
TamraW:
Hello, doctor Falk. Thanks for joining us! I was recently diagnosed with Hashimoto's after suffering from severe gastritis/GERD/heartburn and constipation for over a year. I had an upper GI in January of 2008. I am wondering if my Hashi related condition has caused damage. Would you recommend another upper GI?
Gary W Falk, MD:
Unlikely that Hashimoto's results in GI damage.  Symptoms yes but damage no
ladypar:
what is dysplasia?
Gary W Falk, MD:
Dysplasia is a precancerous change that dramatically increases the chance of developing cancer in Barrett's esophagus at some point in the future. It ABSOLUTELY requires expert pathology confirmation.
Brightlight06:
Are diet and weight control important  when it comes to GERD or Barrett's Esophagus?  
Gary W Falk, MD:
Great question!  Obesity is the single biggest risk factor for Barrett's patients developing cancer.  Treatment of obesity is crucial.  Diet has been answered above.  
ChitChatNine:
How long does it take to develop Barrett's Esophagus when a person has GERD that isn't responding to treatment or is left untreated/undiagnosed?  Is there an age that is more vulnerable -- example: infant with severe GERD vs. adolescent vs. older patient?  And, finally, does severity play a role in the development of Barretts?  Thanks.
Gary W Falk, MD:
The bottom line is that we do not know which patients with GERD will go on to develop Barrett's esophagus.  Key risk factors are erosive or ulcerative esophagitis, obesity and family history.  Classic risks are middle aged Caucasian males!
scopage:
Hello Dr. Falk, was interested in your thoughts on if detecting goblet cells is necessary to render a diagnosis of Barrett's, or just any type of columnar mucosa.
Gary W Falk, MD:
This is an evolving controversial area.  Bottom line is that we still use goblets.  Almost all long segments have goblets.  This area is rapidly evolving however
OwenG47:
I was just diagnosed with GERD, but my doctor has not suggested any treatment yet.  What is the usual medical  treatment for GERD?  
Gary W Falk, MD:
Key points:  no late meals, avoid obvious irritants such as excessive coffee or fatty meals and if those do not work commence medicines that reduce stomach acid.
ladypar:
have inflamation of esophagus ,should i be retested aftyer 1 yr and is this a forth runner to getting barretts
Gary W Falk, MD:
If there are no erosions or ulcers, once in a life time endoscopy is more than adequate.  Multiple studies show that if these features are absent, the risk of developing Barrett's is quite low
BK2005:
What is radiofrequency ablation for Barrett's Esophagus? My doctor mentioned this to me but I don't know what it is.
Gary W Falk, MD:
This is an exciting new treatment where radiofrequency energy is used to burn away the Barrett's segment and replace it with normal esophageal cells.  It has promise in low and high grade dysplasia.  It is controversial and I do not recommend for patients with low grade dysplasia.  Any treament has risks as well as benefits.  
ladypar:
have been on omoprazole 20mg2xd for 2 yrs is this safe taking it longtime , any sideaffects on longtime use?
Gary W Falk, MD:
The goal is lowest dose of medicine to control symptoms.  These drugs are safe but should only be used when people need them.  There may be an association with bone thinning but this is controversial.  Immediate side effects are headache and diarrhea.
scopage:
How effective is standard endoscopy with biopsies at detecting dysplasia? do you see the potential for any of the high resolution endoscopy methods being put in general clinical practice relatively soon?
Gary W Falk, MD:
This is the current standard, that is high resolution white light endoscopy.  There is no clear proof that anything is better yet than a good careful high quality white light exam.  High definiton allows us to see things we did not previously see.  Other imaging techniques are promising but unproven at present.  The most important thing to do is to look carefully and not rush the examination
FurballsMom:
How does a doctor decide when to to an endoscopy to detect a hiatal hernia when a person already has GERD?
Gary W Falk, MD:
Detection of a hiatal henria is not important.  Most of us believe that individuals with regular heartburn that is to say daily warrant a once in a lifetime endoscopy to exclude Barrett's esophagus