Explore options for treating Barrett’s esophagus

Dear Dr. Gott: I recently had an endoscopy and was diagnosed with Barrett’s esophagus. What is the best treatment? Is surgery an option? I read your articles every day and save many of them. Keep up the good work.

Dear Reader: Barrett’s esophagus is a condition in which the lining of the esophagus is replaced by tissue similar to that of the intestine.

The cause of Barrett’s is unknown. It is three to five times more likely to occur in people with gastroesophageal reflux disease. The condition itself, however, has no symptoms. Men are affected nearly twice as often as women, and Caucasian men are at the top of the list.

Some people (fewer than 1 percent) with the condition develop a rare but deadly type of esophageal cancer. The type of cancer associated with Barrett’s esophagus (esophageal adenocarcinoma) is difficult to treat because it is often not found until in the late stages. For this reason, regular examinations, endoscopies and biopsies are necessary. Biopsies can often show precancerous changes, allowing for treatment that may prevent further change in the tissue.

Without symptoms, many physicians recommend adults age 40 and older who have had GERD for a number of years undergo endoscopy and biopsy. These are the only tests available for the diagnosis of the condition.

There are a few treatments available for mild to moderate precancerous changes. Photodynamic therapy uses a light-sensitizing agent and a laser to kill the abnormal cells. Endoscopic mucosal resection involves lifting the Barrett’s lining and then cutting it off. On occasion, both procedures are performed together. A final option is surgical removal of most of the esophagus. This is done only on people with major precancerous changes or full-blown esophageal cancer.

I urge you to return to your gastroenterologist for an explanation of the disorder. He or she is your best resource for information and is the most familiar with your case.

If you would like to learn more about Barrett’s esophagus, go to the National Digestive Diseases Information Clearinghouse’s Web site at digestive.niddk.nih.gov/ddiseases/pubs/barretts or request information by writing to them at 2 Information Way, Bethesda, MD 20892-3570 or by calling (800) 891-5389.

To give you related information, I am sending you a copy of my Health Report “Hiatal Hernia, Acid Reflux and Indigestion.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: You recently suggested a reader raise the head of his bed 3 to 4 inches to help reduce nighttime acid indigestion. However, adding a second pillow can be uncomfortable for some, and wedge pillows can be expensive. I suggest he put the extra pillows under the mattress to raise his head. It is much more comfortable.

Dear Reader: Simply using a second pillow is not an option in this case. This merely raises the head, leaving the neck at an angle. By placing wooden blocks under the feet of the headboard, the entire bed is angled slightly, putting the stomach lower than the head and neck. In this way, gravity keeps the acid in the stomach.