Reflux Esophagitis, also referred to as GERD (gastro-esophageal reflux disease)
has recently received a great degree of attention. Patients talk about it and
even the media talks about it through commercials on prime time TV during the
evening news on all major networks. Although not always a disease but rather a
condition, reflux has been around forever and is here to stay. Nowadays a lot
can be done to control symptoms and improve the quality of life of those who
are affected by it. Approximately 20% of American adults suffer from reflux
symptoms. Reflux or heartburn often causes symptoms but in other individuals
may be asymptomatic. At times it may cause atypical symptoms such as chest pain
(patients think they may be having a heart attack and go to the emergency
room). There are other individuals in whom GERD may cause respiratory symptoms,
which can cause or worsen asthma-like conditions or cause a series of problems
in the larynx. Most commonly these are patients that consult us because they
have a chronic cough or complain of chronic hoarseness.
Hydrochloric acid is produced in the stomach. It has a series of functions,
mainly initiating the process of digestion. The stomach can defend itself from
the low Ph of acid, but this is not the case with the esophagus. Because of
this, there is a sphincter (lower esophageal sphincter or LES), which acts like
a barrier and in this manner; most of the acid is kept away from the stomach.
Some persons have a low sphincter pressure and will have more frequent episodes
of heartburn. Some conditions such as heavy alcohol ingestion, smoking,
obesity, ingestion of high fat containing meals will favor reflux. All
Americans suffer once in a while from reflux, but when this becomes a weekly or
daily condition, patients feel their quality of life is impaired and seek
therapy.
Esophageal cancer (Adenocarcinoma) affected 6000 to 8000 Americans in the year
2000. Over the last thirty years, esophageal cancer has increased over 350%, a
more rapidly rising incidence than all other cancers. Esophageal cancer arises
most often in patients who have a condition known as Barrett’s esophagus.
Barrett’s esophagus is considered by many to be a premalignant precursor to
esophageal cancer. The exact prevalence of Barrett’s esophagus in our country
is unknown but if one considers that close to 20% of adults suffer from reflux
and 10 to 15% of patients with chronic reflux will have Barrett’s esophagus,
one could predict that perhaps 1 to 2% of American adults may have “Barrett’s”.
These are the people who are “contributing” to the rapid rise of esophageal
cancer.
Barrett’s esophagus is associated with GERD. Most patients with Barrett’s
esophagus will not develop esophageal cancer. This is the good news and we do
not want anybody reading this information to be alarmed and think that just
because they have symptoms of heartburn they are going to die of esophageal
cancer, but it probably is wise and pays off to be proactive.
By being pro-active, patients with chronic reflux above a certain age (the age
may change pending the age of first noticing symptoms as well as the frequency)
should undergo an upper gastrointestinal endoscopy, also known as an EGD
(esophago-gastroduodenoscopy). During this procedure, your physician will look
down through your throat and into your esophagus and stomach while you are
comfortably sedated. During this procedure, your doctor will determine how
severe your reflux is and will usually be able to tell you if you have
developed Barrett’s esophagus or not. If you do have Barrett’s, treatment of
heartburn is usually a bit more aggressive and for a longer period of time.
Also, having Barrett’s esophagus, your doctor may recommend that you undergo an
endoscopy more frequently than those patients that do not have this condition.
When this is the case, rarely does on have to undergo an endoscopy more than
once every one or two years.
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