Barrett's and surgery

  I'm a 24 year old woman who was diagnosed with Barrett's Esophagus about six/seven years ago. I spend about 3 years on medication for this, but eventually the pain and heartburn returned. It was elected that I undergo the surgery to treat this known as a Nissan Fundoplication or wrap (unsure of spelling). Since then, I have not had the problems with pain and heartburn I was having.
  Recently, I have noticed a slight tightness in my chest and a little pain. My mother (also diagnosed with this) told me that a new internist informed her that the surgery doesn't "cure" Barrett's and that I should still be checked regularly for this.
  I'm a bit concerned, since I haven't been scoped in approximately 3 years. Do I really have something to worry about? Should I be scoped again on a regular basis?
Dear Jennifer,
As you know, Barrett's esophagus refers to a change in the lining of the lower esophagus where the normal pinkish lining is
replaced with a darker, red lining (looks more like the stomach lining). It is necessary to biopsy this area because an increased
chance of developing esophageal adenocarcinoma is present only if intestinal metaplasia (intestinal glands are present on
biopsies of the lower esophagus) is noted.
There is no routine modality that is used that has been proven to reverse or destroy Barrett's epithelium. Researchers have used
specialized techniques such as bipolar electrocoagulation (cautery), photodynamic therapy and laser treatments to destroy
Barrett's epithelium with variable success rates. Prolonged acid suppression (with omeperazole and lansoprazole) and Nissen
fundoplication have not consistently been proven to alter Barrett's epithelium.
Therefore, I would recommend that you have surveillance endoscopies every two years or so if it is documented that you have
intestinal metaplasia.
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.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an
appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: Barrett's esophagus, surveillance, treatment

[HFHSM.D.-ym]