Treatment

[mem]

My husband has been treated my our family physcian for acid reflux for many years.His dr prescribed pyloxac for treatment.In Dec. he had a physical and a stress test. The physcial and stess test were fine.The endoscopy which was part of the physical was scheduled in Jan.Our family dr only orders this test when you turn 50.In Jan.he was rushed to the emergency twice for pains in his chest and he has having a hard time breathing.The drs said his heart was fine.His esophagus test showed he had Barrett's esophahus. He is on 4 Nexium a day 40mg.The dr. also told him 1/3 of his esophagus is gone. The dr. told him to come back in a year to have another endoscopy.I feel my husband should have been monitored better my his family physcian.He knew my husband smoked and drank which is all the more reason to monitor the esophahus.If he had ordered my husband an endoscopy years ago he might not be in this condition today.I really I'm afaid this will turn into cancer.The Dr. will only allow 4 Nexium a day that is the max.I want my husband to have the best medical treatment neccasary so, he live a long life.Everyone I talked to who was had acid reflux had been ordered an endoscopy by their dr right away. None have these people are under a HMO plan,we are.Are there better treatments out there for his problem?If so  would you please let me know. I just want the best of  care for him.Thanks!

[Kevin Pho, MD]

Hello - thanks for asking your question.

The optimal treatment for Barrett's esophagus depends on the grade of dysplasia (i.e. low vs high grade) - this should be noted on the endoscopy report.  Obviously, control of the esophageal reflux should be maintained.

For patients with low-grade dysplasia, surveillance endoscopy every six months for the first year should be recommended, followed by yearly endoscopy if the dysplasia has not progressed in severity.

For patients with high-grade dysplasia confirmed by an expert pathologist, two alternatives are reasonable and should be considered in the context of individual patient circumstances: intensive endoscopic surveillance (eg, every three months) until intramucosal carcinoma is detected, or esophageal resection.

Photodynamic (i.e. with a light-activated drug) and ablative (i.e. laser ablation) therapies for Barrett's esophagus remain experimental. These modalities can be considered provided that they are performed as part of an established research protocol.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Spechler.  Management of Barrett's Esophagus.  UptoDate, 2003.

[tessa0825]

Hi..Im sure Dr Kevin will give you alot of advise but I would call his Dr. and ask for some explanations...Such as, what does 1/3 of his esophagus being gone mean? Also, if he has Barrets then you need to know at what stage of progression he is at...There are(3) 1. No dysplasia whitch is called metaplasia 2. Low grade dysplasia, and, 3. high-grade dysplasia.....His treatment and surveillance depends on where he is at right now..When you say he isnt being rebiopsied for a yr. that sounds like Metaplasia but I would sure find out....Also, 160mg nexium a day?....WOW.........Thats more than Ive ever heard of anyone taking...Did he start at a lower dose and increase to that or was that the initial dose he was prescribed?.....Best of luck to you......Tessa...P.S. ...Iam in no way a medical professional Im just another pt with barretts.....

[mem]

Thanks for the info. I will check with his dr. My husband never was on nexium. The dr started him on 4 nexium aday 40mg right away after his test. I will keep you post.

[kskatz]

I too have recently been diagnosed with Barrett's Esophagus and do not have enough information as to know whether or not to be worried about getting cancer. How oftern does this turn to cancer?

[tessa0825]

Hello, fortunately not often, but it can....It is a very small percentage that progress to EC...You dont say but do you have dysplasia or only metaplasia (no dysplasia)?.....If you reply please ask any questions and hopefully I can steer you in the right area....There is  alot of good info on the net about barretts but you have to make sure you get it from reliable sources such as big training hospitals like John Hopkins, or Mayo, or seattles barretts esophagus program..Here is the best Barretts site I have found....
http://www.barrettsinfo.com/content/1_what_is_barretts.htm.......Will look for your response.............Take care.....Tessa

[Energy]

I have also been diagnosed with Barretts.  I am concerned that this increases cancer risk.  They say that Barretts is irreversable.  What can I do to minimize the risk of cancer?

[tessa0825]

hello, you can stay on your PPIS, keep the head of your bed elevated, try and reduce stress, follow the GERD diet, and make sure you have your follow up EGDs and biopsies.....Tessa