DO YOU GET HEARTBURN? Stomach contents heading back into the esophagus (gastroesophageal reflux) are not unexpected. For many, these episodes are fleeting and do not cause symptoms or injury to the esophagus.

Gastroesophageal reflux becomes a problem when it causes significant damage to the esophagus or symptoms.

Today we look at the physiology of gastroesophageal reflux, causes, symptoms, diagnosis, and potential non-medical interventions for management.

We’ll end with the observation that those who sleep on their left side have less potentially harmful stomach acid than others.

What is reflux (GERD)?

At your stomach’s entrance is a functional valve, a muscle ring known as the lower esophageal sphincter (LES). Usually, the LES closes after food passes through it.

If the sphincter does not entirely close (or it opens too frequently), stomach acid can move backward into your esophagus. With this retrograde acid flow, one can experience symptoms such as burning chest discomfort or heartburn.

WebMD offers that if acid reflux symptoms happen more than twice per week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

If your symptoms of acid reflux occur more than twice weekly, you may have gastroesophageal (acid) reflux disease.

Reflux: Common risk factors

A common cause of acid reflux is a hiatal hernia. This condition happens when the upper stomach and the lower esophageal sphincter slip above the diaphragm (the muscle separating your stomach from the chest). If you have a hiatal hernia, acid can more easily move up into your esophagus, causing acid reflux disease.

Other risk factors for acid reflux disease include:

• Being overweight or obese
• Consuming large meals or lying down right after eating
• Eating certain foods, for example, such as spicy or fatty foods. Some get heartburn from citrus, tomato, mint, garlic, or onions.
• Drinking beverages such as alcohol, carbonated drinks, coffee, or tea
• Smoking
• Being pregnant
• Taking certain medicines (aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines are examples)

Reflux (GERD): Symptoms

The Mayo Clinic (USA) explains that common symptoms of gastroesophageal reflux disease (GERD) include:

• Chest pain
• Heartburn (a burning sensation in your chest, typically after eating). Heartburn can be worse at night.
• Swallowing difficulty
• Regurgitation of food or sour liquid
• Lump in your throat sensation

This burning can occur anytime but is often worse after eating. For many, heartburn gets worse when they recline or lie in bed, making getting good sleep a challenge.

The Mayo Clinic offers that you should seek immediate medical care if you have chest pain (especially if you also have shortness of breath or jaw or arm pain). These may be symptoms of a heart attack.

Make an appointment with your doctor if you have severe or frequent GERD symptoms. Also, check-in with your healthcare provider if you use over-the-counter medications for heartburn more than twice weekly.

The perils of GERD

Did you know that more than 75 percent of individuals with asthma have GERD? Those with asthma are twice as likely to have GERD as those without the condition.

Gastroesophageal reflux disease may worsen asthma symptoms, and asthma drugs can worsen GERD. But treating GERD often helps to relieve asthma symptoms. The mechanism of action is not clear.

GERD (chronic acid reflux) can be dangerous or even life-threatening. It’s not the GERD per see that is the issue; instead, chronic GERD can promote:

• Esophagus inflammation (esophagitis). Stomach acid can irritate and inflame the esophagus lining, culminating in heartburn, chest pain, bleeding, or challenges swallowing.
• Barrett’s esophagus. About ten percent of those with chronic GERD develop this condition. Here, the long-term damage from acid hitting the esophagus lining can cause cells to be abnormal; when this occurs, we call it Barrett’s esophagus, a risk factor for esophagus cancer.
• Esophagus cancer. Adenocarcinoma is a cancer type that typically develops in the lower esophagus. Squamous cell carcinoma more commonly affects the middle and upper esophagus.
• Strictures. The damaged esophagus sometimes becomes scarred, resulting in narrowing of the structure. Strictures can make drinking or eating challenging.

GERD and sleep position

Medicines can help with GERD. Many can benefit from lifestyle interventions. For example, try sleeping on your left side. This position appears to be the best sleeping one for people with GERD, as it reduces reflux episodes. On the other hand, sleeping on your back can make reflux more likely.

An old-school trick is to raise the head of the bed. Propping it up (not just putting more pillows under your head) by at least six inches may reduce your reflux when you are lying down.

You can find some more intense interventions for GERD here:Treatment for GER & GERD | NIDDKYour doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal…www.niddk.nih.gov.

GERD — my take

If you have symptoms of GERD, please discuss them with a healthcare provider. Having a good weight can help us dodge acid reflux. In addition, don’t eat overly large meals or lie down immediately after eating.

Be careful with spicy or fatty foods, citrus, tomato, garlic, mint, and onions. I try to avoid peppermint in the evening but have no trouble with it during other times of the day.

I don’t drink alcohol but do consume e risk-increasing coffee and tea. I am sure you are not surprised that I don’t smoke. Finally, be careful with the medicines such as aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines.

The post Heading Off Heartburn appeared first on Medika Life.

Crohn’s disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

Crohn’s disease most often begins gradually and can become worse over time. You may have periods of remission that can last for weeks or years.

How common is Crohn’s disease?

Researchers estimate that more than half a million people in the United States have Crohn’s disease. Studies show that, over time, Crohn’s disease has become more common in the United States and other parts of the world. Experts do not know the reason for this increase.

Who is more likely to develop Crohn’s disease?

Crohn’s disease can develop in people of any age and is more likely to develop in people

• between the ages of 20 and 29
• who have a family member, most often a sibling or parent, with IBD
• who smoke cigarettes

What are the complications of Crohn’s disease?

Complications of Crohn’s disease can include the following:

• Intestinal obstruction. Crohn’s disease can thicken the wall of your intestines. Over time, the thickened areas of your intestines can narrow, which can block your intestines. A partial or complete intestinal obstruction, also called a bowel blockage, can block the movement of food or stool through your intestines.
• Fistulas. In Crohn’s disease, inflammation can go through the wall of your intestines and create tunnels, or fistulas. Fistulas are abnormal passages between two organs, or between an organ and the outside of your body. Fistulas may become infected.
• Abscesses. Inflammation that goes through the wall of your intestines can also lead to abscesses. Abscesses are painful, swollen, pus-filled pockets of infection.
• Anal fissures. Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.
• Ulcers. Inflammation anywhere along your digestive tract can lead to ulcers or open sores in your mouth, intestines, anus, or perineum.
• Malnutrition. Malnutrition develops when your body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.
• Inflammation in other areas of your body. You may have inflammation in your joints, eyes, and skin.

What other health problems do people with Crohn’s disease have?

If you have Crohn’s disease in your large intestine, you may be more likely to develop colon cancer. If you receive ongoing treatment for Crohn’s disease and stay in remission, you may reduce your chances of developing colon cancer.³

Talk with your doctor about how often you should get screened for colon cancer. Screening is testing for diseases when you have no symptoms. Screening for colon cancer can include colonoscopy with biopsies. Although screening does not reduce your chances of developing colon cancer, it may help to find cancer at an early stage and improve the chance of curing the cancer

Symptoms & Causes

What are the symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are

• diarrhea
• cramping and pain in your abdomen
• weight loss

Other symptoms include

• anemia
• eye redness or pain
• feeling tired
• fever
• joint pain or soreness
• nausea or loss of appetite
• skin changes that involve red, tender bumps under the skin

Your symptoms may vary depending on the location and severity of your inflammation.

Some research suggests that stress, including the stress of living with Crohn’s disease, can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms.

What causes Crohn’s disease?

Doctors aren’t sure what causes Crohn’s disease. Experts think the following factors may play a role in causing Crohn’s disease.

Autoimmune reaction

One cause of Crohn’s disease may be an autoimmune reaction—when your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn’s disease.

Genes

Crohn’s disease sometimes runs in families. Research has shown that if you have a parent or sibling with Crohn’s disease, you may be more likely to develop the disease. Experts continue to study the link between genes and Crohn’s disease.

Other factors

Some studies suggest that other factors may increase your chance of developing Crohn’s disease:

• Smoking may double your chance of developing Crohn’s disease.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, antibiotics, and birth-control pills may slightly increase the chance of developing Crohn’s disease.
• A high-fat diet may also slightly increase your chance of getting Crohn’s disease.

Stress and eating certain foods do not cause Crohn’s disease.

Diagnosis

How do doctors diagnose Crohn’s disease?

Doctors typically use a combination of tests to diagnose Crohn’s disease. Your doctor will also ask you about your medical history—including medicines you are taking—and your family history and will perform a physical exam.

Physical exam

During a physical exam, a doctor most often

• checks for bloating in your abdomen
• listens to sounds within your abdomen using a stethoscope
• taps on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged

Diagnostic tests

Your doctor may use the following tests to help diagnose Crohn’s disease:

• lab tests
• intestinal endoscopy
• upper gastrointestinal (GI) series
• computed tomography (CT) scan

Your doctor may also perform tests to rule out other diseases, such as ulcerative colitis, diverticular disease, or cancer, that cause symptoms similar to those of Crohn’s disease.

What tests do doctors use to diagnose Crohn’s disease?

Your doctor may perform the following tests to help diagnose Crohn’s disease.

Lab tests

Lab tests to help diagnose Crohn’s disease include:

Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for changes in

• red blood cells. If your red blood cells are fewer or smaller than normal, you may have anemia.
• white blood cells. When your white blood cell count is higher than normal, you may have inflammation or infection somewhere in your body.

Stool tests. A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Doctors use stool tests to rule out other causes of digestive diseases.

Intestinal endoscopy

Intestinal endoscopies are the most accurate methods for diagnosing Crohn’s disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies include the following:

Colonoscopy. Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon. The doctor may also examine your ileum to look for signs of Crohn’s disease.

A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.

During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and colon and into the lower part of your ileum. If your doctor suspects that you have Crohn’s disease, the colonoscopy will include biopsies of your ileum, colon, and rectum. You won’t feel the biopsies.

Upper GI endoscopy and enteroscopy. In an upper GI endoscopy, your doctor uses an endoscope to see inside your upper digestive tract, also called your upper GI tract.

A trained specialist performs the procedure at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI endoscopy. You most often receive a liquid anesthetic to numb your throat and a light sedative to help you stay relaxed and comfortable during the procedure.

During the procedure, the doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum.

During an enteroscopy, a doctor examines your small intestine with a special, longer endoscope using one of the following procedures:

• push enteroscopy, which uses a long endoscope to examine the upper portion of your small intestine
• single- or double-balloon enteroscopy, which uses small balloons to help move the endoscope into your small intestine
• spiral enteroscopy, which uses a tube attached to an endoscope that acts as a corkscrew to move the instrument into your small intestine

Capsule endoscopy. In capsule endoscopy, you swallow a capsule containing a tiny camera that allows your doctor to see inside your digestive tract. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for a capsule endoscopy. You don’t need anesthesia for this procedure.

The test begins in a doctor’s office, where you swallow the capsule. You can leave the doctor’s office during the test. As the capsule passes through your digestive tract, the camera will record and transmit images to a small receiver device that you wear. When the recording is done, your doctor downloads and reviews the images. The camera capsule leaves your body during a bowel movement, and you can safely flush it down the toilet.

Upper GI series

An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy, and a chalky liquid called barium to view your upper GI tract.

An x-ray technician and a radiologist perform this test at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI series. You don’t need anesthesia for this procedure.

For the procedure, you’ll be asked to stand or sit in front of an x-ray machine and drink barium. The barium will make your upper GI tract more visible on an x-ray. You will then lie on the x-ray table, and the radiologist will watch the barium move through your upper GI tract on the x-ray and fluoroscopy.

CT scan

A CT scan uses a combination of x-rays and computer technology to create images of your digestive tract.

For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. CT scans can diagnose both Crohn’s disease and the complications of the disease.

Treatment

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

• balsalazide
• mesalamine
• olsalazine
• sulfasalazine

Some of the common side effects of aminosalicylates include

• diarrhea
• headaches
• heartburn
• nausea and vomiting
• pain in your abdomen

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

• budesonide
• hydrocortisone
• methylprednisolone
• prednisone

Side effects of corticosteroids include

• acne
• bone mass loss
• high blood glucose
• high blood pressure
• a higher chance of developing infections
• mood swings
• weight gain

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

• 6-mercaptopurine, or 6-MP
• azathioprine
• cyclosporine
• methotrexate

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

• a low white blood cell count, which can lead to a higher chance of infection
• feeling tired
• nausea and vomiting
• pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

• anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab , and infliximab
• anti-integrin therapies, such as natalizumab and vedolizumab
• anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

• acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
• antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
• loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

• ask you to drink a liquid that contains nutrients
• give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
• give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.⁸ Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

• fistulas
• bleeding that is life threatening
• intestinal obstructions
• side effects from medicines when they threaten your health
• symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

• laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

• laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

• Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
• Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
• Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
• Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
• Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
• Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
• Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines

Eating, Diet, & Nutrition

How can my diet help the symptoms of Crohn’s disease?

Changing your diet can help reduce symptoms. Your doctor may recommend that you make changes to your diet such as

• avoiding carbonated, or “fizzy,” drinks
• avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• drinking more liquids
• eating smaller meals more often
• keeping a food diary to help identify foods that cause problems

Depending on your symptoms or medicines, your doctor may recommend a specific diet, such as a diet that is

• high calorie
• lactose free
• low fat
• low fiber
• low salt

Talk with your doctor about specific dietary recommendations and changes.

Your doctor may recommend nutritional supplements and vitamins if you do not absorb enough nutrients. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you 

The post Crohn’s Disease. Symptoms, Diagnosis, and Treatment appeared first on Medika Life.

Are people with Barrett’s esophagus more likely to develop cancer?

People with Barrett’s esophagus are more likely to develop a rare type of cancer called esophageal adenocarcinoma.

The risk of esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5 percent per year. Typically, before this cancer develops, precancerous cells appear in the Barrett’s tissue. Doctors call this condition dysplasia and classify the dysplasia as low grade or high grade.

You may have Barrett’s esophagus for many years before cancer develops.

How common is Barrett’s esophagus?

Experts are not sure how common Barrett’s esophagus is. Researchers estimate that it affects 1.6 to 6.8 percent of people.

Who is more likely to develop Barrett’s esophagus?

Men develop Barrett’s esophagus twice as often as women, and Caucasian men develop this condition more often than men of other races. The average age at diagnosis is 55. Barrett’s esophagus is uncommon in children

What are the symptoms of Barrett’s esophagus?

While Barrett’s esophagus itself doesn’t cause symptoms, many people with Barrett’s esophagus have gastroesophageal reflux disease (GERD), which does cause symptoms.

What causes Barrett’s esophagus?

Experts don’t know the exact cause of Barrett’s esophagus. However, some factors can increase or decrease your chance of developing Barrett’s esophagus.

What factors increase a person’s chances of developing Barrett’s esophagus?

Having GERD increases your chances of developing Barrett’s esophagus. GERD is a more serious, chronic form of gastroesophageal reflux, a condition in which stomach contents flow back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

Between 10 and 15 percent of people with GERD develop Barrett’s esophagus.

Obesity—specifically high levels of belly fat—and smoking also increase your chances of developing Barrett’s esophagus. Some studies suggest that your genetics, or inherited genes, may play a role in whether or not you develop Barrett’s esophagus.

What factors decrease a person’s chances of developing Barrett’s esophagus?

Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. While the bacteria damage your stomach and the tissue in your duodenum, some researchers believe the bacteria make your stomach contents less damaging to your esophagus if you have GERD.

Researchers have found that other factors may decrease the chance of developing Barrett’s esophagus, including

• frequent use of aspirin or other nonsteroidal anti-inflammatory drugs
• a diet high in fruits, vegetables, and certain vitamins

Diagnosis

How do doctors diagnose Barrett’s esophagus?

Doctors diagnose Barrett’s esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. Doctors may diagnose Barrett’s esophagus while performing tests to find the cause of a patient’s gastroesophageal reflux disease (GERD) symptoms.

Medical history

Your doctor will ask you to provide your medical history. Your doctor may recommend testing if you have multiple factors that increase your chances of developing Barrett’s esophagus.

Upper GI endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care provider uses an endoscope to see inside your upper GI tract, most often while you receive light sedation. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. The procedure may show changes in the lining of your esophagus.

The doctor performs a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab to determine whether Barrett’s esophagus cells are present. A pathologist who has expertise in diagnosing Barrett’s esophagus may need to confirm the results.

Barrett’s esophagus can be difficult to diagnose because this condition does not affect all the tissue in your esophagus. The doctor takes biopsy samples from at least eight different areas of the lining of your esophagus.

Who should be screened for Barrett’s esophagus?

Your doctor may recommend screening for Barrett’s esophagus if you are a man with chronic—lasting more than 5 years—and/or frequent—happening weekly or more—symptoms of GERD and two or more risk factors for Barrett’s esophagus. These risk factors include

• being age 50 and older
• being Caucasian
• having high levels of belly fat
• being a smoker or having smoked in the past
• having a family history of Barrett’s esophagus or esophageal adenocarcinoma

Treatment

How do doctors treat Barrett’s esophagus?

Your doctor will talk about the best treatment options for you based on your overall health, whether you have dysplasia, and its severity. Treatment options include medicines for GERD, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.

Periodic surveillance endoscopy

Your doctor may use upper gastrointestinal endoscopy with a biopsy periodically to watch for signs of cancer development. Doctors call this approach surveillance.

Experts aren’t sure how often doctors should perform surveillance endoscopies. Talk with your doctor about what level of surveillance is best for you. Your doctor may recommend endoscopies more frequently if you have high-grade dysplasia rather than low-grade or no dysplasia.

Medicines

If you have Barrett’s esophagus and gastroesophageal reflux disease (GERD), your doctor will treat you with acid-suppressing medicines called proton pump inhibitors (PPIs). These medicines can prevent further damage to your esophagus and, in some cases, heal existing damage.

PPIs include

• omeprazole (Prilosec, Zegerid)
• lansoprazole (Prevacid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)
• esomeprazole (Nexium)
• dexlansoprazole (Dexilant)

All of these medicines are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.

Your doctor may consider anti-reflux surgery if you have GERD symptoms and don’t respond to medicines. However, research has not shown that medicines or surgery for GERD and Barrett’s esophagus lower your chances of developing dysplasia or esophageal adenocarcinoma.

Endoscopic ablative therapies

Endoscopic ablative therapies use different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should begin making normal esophageal cells.

A doctor, usually a gastroenterologist or surgeon, performs these procedures at certain hospitals and outpatient centers. You will receive local anesthesia and a sedative. The most common procedures are the following:

• Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in your esophagus. A doctor injects porfimer into a vein in your arm, and you return 24 to 72 hours later to complete the procedure.

Complications of photodynamic therapy may include

• sensitivity of your skin and eyes to light for about 6 weeks after the procedure
• burns, swelling, pain, and scarring in nearby healthy tissue
• coughing, trouble swallowing, stomach pain, painful breathing, and shortness of breath.

• Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells in the Barrett’s tissue. An electrode mounted on a balloon or an endoscope creates heat to destroy the Barrett’s tissue and precancerous and cancerous cells.

Complications of radiation ablation may include

• chest pain
• cuts in the lining of your esophagus
• strictures

Clinical trials have shown that complications are less common with radiofrequency ablation compared with photodynamic therapy.

Endoscopic mucosal resection

In endoscopic mucosal resection, your doctor lifts the Barrett’s tissue, injects a solution underneath or applies suction to the tissue, and then cuts the tissue off. The doctor then removes the tissue with an endoscope. Gastroenterologists perform this procedure at certain hospitals and outpatient centers. You will receive local anesthesia to numb your throat and a sedative to help you relax and stay comfortable.

Before performing an endoscopic mucosal resection for cancer, your doctor will do an endoscopic ultrasound.

Complications can include bleeding or tearing of your esophagus. Doctors sometimes combine endoscopic mucosal resection with photodynamic therapy.

Surgery

Surgery called esophagectomy is an alternative to endoscopic therapies. Many doctors prefer endoscopic therapies because these procedures have fewer complications.

Esophagectomy is the surgical removal of the affected sections of your esophagus. After removing sections of your esophagus, a surgeon rebuilds your esophagus from part of your stomach or large intestine. The surgery is performed at a hospital. You’ll receive general anesthesia, and you’ll stay in the hospital for 7 to 14 days after the surgery to recover.

Surgery may not be an option if you have other medical problems. Your doctor may consider the less-invasive endoscopic treatments or continued frequent surveillance instead.

Eating, Diet, & Nutrition

How can your diet help prevent Barrett’s esophagus?

Researchers have not found that diet and nutrition play an important role in causing or preventing Barrett’s esophagus.​

If you have gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD), you can prevent or relieve your symptoms by changing your diet. Dietary changes that can help reduce your symptoms include

• decreasing fatty foods
• eating small, frequent meals instead of three large meals

Avoid eating or drinking the fol​lowing items that may make GER or GERD worse:

• ​chocolate
• coffee
• peppermint
• greasy or spicy foods​
• tomatoes and tomato products
• alcoholic drinks

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you

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