I was seeing a patient back in the office after she had undergone a diagnostic upper endoscopy for esophageal reflux symptoms. She was accompanied by her daughter and was devastated by the results of her procedure. She was found to have damage at the end of her esophagus where it empties into the stomach. This connection is referred to the gastroesophageal junction (GEJ) and is the location where we damage our esophagus from ongoing reflux of contents from the stomach and duodenum into the esophagus.
The damage that had occurred was a change in the skin lining of the GEJ that is called Barrett’s esophagus (BE). The incidence of BE has steadily increased in America since the 1970’s. As the frequency of BE has risen, so has adenocarcinoma of the esophagus. The reason for this is that BE is the precursor for development of this cancer. The transition to cancer is quite infrequent (0.15 to 0.45%%/year depending on the study) in America but it is nearly 4% in England. It is important to realize, however, that the incidence of this cancer in the US has increased over 300% since the 1970’s.
The patient, her daughter and I had a lengthy discussion concerning the endoscopic findings. Once she was calmed down, the patient became quite engaged in outlining a long term management strategy in an attempt to reduce her risk of developing cancer. While we have no guarantees, we came to a consensus that made sense to both of us.
If you would like to read a more detailed article on this topic, visit the store where you will find an in depth report about Barrett’s esophagus.