March 3, 2016
Esophageal diseases are complex and involve a multimodality approach to diagnosis and treatment. Specialists in General Surgery and North Memorial have recently created a new esophageal center to manage and treat patients with esophageal diseases.
Cases of Barrett’s esophagus and esophageal adenocarcinoma are growing at an alarming rate, according to Kourtney Kemp, MD, due in part to the increased long-term use of proton pump inhibitors (PPIs). She reasons that many physicians prescribe PPIs for their patients without identifying the cause of acid reflux, which creates most patients’ symptoms. While PPIs are approved for 16 weeks, many patients remain on the medication for years.
“There is increasing evidence that PPIs have contributed to the increase in adenocarcinoma,” she explained in an issue of Maple Grove Hospital Provider News. “PPIs are used to lower the acid content by increasing the overall pH of the refluxant. Although the refluxant has less acid content, the patient still has reflux episodes. Symptoms improve due to the lack of acid reflux, however, reflux is complex and involves both acid and bile. In acidic environments, bile precipitates out and doesn’t cause harm. However, in non-acidic environments, such as with PPI use, the bile is in soluble form. The soluble form of bile is extremely toxic to the esophagus lining causing cellular damage and eventually Barrett’s transformation. Acidic reflux can cause symptoms, while Barrett’s is a silent disease due to the change in esophageal lining. Barrett’s, over time, can change into adenocarcinoma.”
The best treatment for Barrett’s, according to Dr. Kemp, is to identify its cause and reduce or eliminate the use of PPIs. This might involve diet or surgery, either weight loss surgery or surgery to create a more competent sphincter between the stomach and the esophagus, protecting against both acid and bile reflux. In addition to causing Barrett’s, PPIs have been linked to bone fractures, Plavix drug interactions and C. diff infections.
The new center at North Memorial offers high-resolution esophageal motility testing and pH monitoring. Esophageal motility can be used to diagnose GERD, heartburn, dysphagia, swallowing dysfunction, regurgitation and evaluation of atypical symptoms of chest pain, chronic cough and asthma. pH monitoring is an added method of identifying reflux in symptomatic patients whose esophagus is normal.
The new center also provides esophagogastroduodenoscopy (EGD) screening and evaluation for patients over the age of 50 who have been taking PPIs for more than 16 weeks. Soon, the center also will offer radiofrequency ablation (RFA) for treatment of Barrett’s esophagus in two or three short outpatient treatments, followed by a minimally invasive surgical procedure to address the cause of the reflux.
If you suffer from esophageal disease and want to learn more about our services, please call 763.780.6699 for an appointment with one of our surgeons.