Barrett's Esophagus diagnosis

  Please help! I was diagnosed with Barrett's esophagus last month.  I have not been able to talk to the gastroenterologist who did the endoscopy, but was sent a brochure about Barrett's esophagus, and told to come back in one year to be retested, as there was a high risk of developing cancer.  I also was prescribed Prevacid, 30 mg./once per day.  The medicine has been very helpful, but I have been very anxious to find out more about this condition.  I went to my regular doctor, an internist, who tells me that he can do the endoscopies and treat this condition, and he recommends the endoscpy every six months.  He also tells me the condition can be reversed.
  I am so confused.  Do I need to be referred to another gastroenterolist for treatment or is it probably OK to go to my regular doctor? What are my chances for developing cancer if I follow the treatment advice (lose weight, cut out caffeine, and get tested every six months)?  I am 37, my lab report said focal Barretts, epithelial component, no dysplasia).  What are the long-term effects of the Prevacid?  What other treatment options are available?
  Thank you!
Dear Debbie,
Barrett's esophagus is a change in the lining of the lower foodpipe. If the lining looks like the lining of the intestine it is called intestinal metaplasia and is associated with a higher risk of developing esophageal adenocarcinoma. Therefore, if this lesion is identified, it is currently recommended to have periodic endoscopies with biopsies to look for dysplasia (glandular distortion) that may develop in this tissue. Dysplasia is the first sign that cancer may occur in the esophagus.
Shorter segments of intestinal metaplasia are currently referred to as short segment Barrett's esophagus. It remains unclear whether short segment Barrett's esophagus carries the same, less or no risk of developing adenocarcinoma of the esophagus. If high grade dysplasia is present on tissue biopsies taken during endoscopy the standard treatment is surgical resection. However, other treatments (such as photodynamic therapy, bipolar coagulation, argon plasma coagulation)to destroy the tissue in this area are being researched. More research is needed before these methods can be routinely recommended.
Adenocarcinoma of the esophagus develops in Barrett's esophagus at the rate of about one cancer per 125 patient years of follow-up. This converts to an annual incidence in an adult patient with Barrett's esophagus of 0.8%.
Medications to suppress acid such as lansoprazole (Prevacid) help suppress inflammation but have not been shown to significantly reverse Barrett's esophagus. It is thought that by suppressing inflammation, one can prevent further damage to the lower esophagus and thus prevent the development of cancer. This hypothesis has never been proven. Proton pump inhibitors such as omeperazole (Prilosec) and lansoprazole (Prevacid) have been used in European patients for at least 5 years with good effect and low incidence of side effects. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
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