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Medical Edge Newspaper Column from Mayo Clinic

OUTPATIENT OPTIONS FOR BARRETT’S ESOPHAGUS

DEAR MAYO CLINIC: I am writing from Italy, and I need information about Barrett’s esophagus therapy. Can you help me?

ANSWER: Reliable information on Barrett’s esophagus therapy is available from physicians who specialize in its treatment, various health education books and publications, and select Internet sites such as www.barrettsinfo.com.

I can get you started on the topic. Barrett’s esophagus is a relatively uncommon disease of the lower part of the esophagus (food tube). It’s a change in the esophagus from its normal “squamous” lining — which is like the skin on the back of your hand — to a “specialized columnar” lining, which is more like the lining of your small intestine.

The condition is related to acid reflux disease (heartburn), a malfunction of the digestive system in which stomach acid enters the lower end of the esophagus. Cells lining the esophagus that are repeatedly exposed to stomach acid can be replaced by abnormal cells, resulting in Barrett’s esophagus. While lifestyle changes such as losing weight, stopping smoking, exercising more and making healthy food choices help decrease acid reflux, they do not eliminate the risk of cancer. Once Barrett’s esophagus is diagnosed, a patient is at increased risk of developing esophageal cancer.

Patients who may have Barrett’s esophagus undergo endoscopy — a test that uses a small tube to see the esophagus — to determine the presence or degree of dysplasia, or change, in esophageal tissue. Dysplasia is a precursor to cancer. Generally speaking, patients who don’t have dysplasia can be safely observed with periodic endoscopy and repeated biopsies. Even those who have dysplasia can be monitored with endoscopy — though physicians may want to test more often.

The following are outpatient treatments, which specialists may recommend for patients who meet certain criteria:

— Photodynamic therapy. Providers inject photosensitive dye and apply laser light to the dye to kill the abnormal cells on the lower esophagus.

— Endoscopic Mucosal Resection: This technique takes large pieces — sometimes all of the Barrett’s tissue — from the esophagus. The tissue can then be examined for signs of dysplasia or cancer.

— Thermal techniques: These therapies use heat to destroy abnormal cells and promote regrowth of normal cells. The way the heat is applied varies. The most commonly used technique is multipolar coagulation. Argon plasma coagulation and argon laser are other methods.

Please note that all of these techniques have some negative side effects and varying levels of effectiveness. Be sure to discuss them with your physician before selecting a treatment method.

Treating Barrett’s esophagus is challenging, so you need to seek out a specialist in gastroenterology who is familiar with the disease, the treatments available and their respective benefits.

Kenneth Wang, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Barrett's Esophagus
Appointment Information
More Information on Barrett's Esophagus

READERS: While Alzheimer’s disease is the most well-known cause of memory loss and hazy mental processing in the elderly, there are other possible explanations as well. One such explanation for reduced mental ability is vascular dementia, which is often mistaken for Alzheimer’s.

Vascular dementia occurs when small blood vessels in the brain become blocked or narrowed due to critical narrowing of the caliber of the blood vessels or to blood clots. These blockages inhibit blood circulation, often causing permanent brain damage. Vascular dementia is often mistaken for Alzheimer’s disease because the symptoms of the two disorders are nearly identical. The development of the two, however, is quite different. While Alzheimer’s disease usually develops gradually and at a steady rate, vascular dementia frequently develops suddenly, often following a stroke.

Some of the risk factors for vascular dementia include a history of stroke, cigarette smoking, high blood pressure and diabetes. Atherosclerosis, a condition in which fatty plaques build up inside the arteries, is another risk factor of vascular dementia. While there is no known cure for vascular dementia, medications may help to slow the progress of the disorder. Avoiding cigarettes and reducing cholesterol can also slow progression.

Additional Resources:
Treatment of Vascular Dementia
Appointment Information
More Information on Vascular Dementia

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.