#Barretts esophagus

[mcatmemoranda]

From UpToDate:

Overview — The goal of surveillance is to improve outcomes by detecting dysplasia or esophageal adenocarcinoma early enough to provide effective treatment. Guidelines suggest surveillance for most patients with Barrett's esophagus, but whether surveillance is beneficial is unclear. Available observational studies have not consistently shown that surveillance is beneficial. In addition, there are potential harms associated with surveillance, including a decrease in quality of life due to worry about cancer development, the risks associated with endoscopy, the risks and morbidity associated with invasive therapies used to treat lesions identified by surveillance (such as esophagectomy or radiofrequency ablation), and missed lesions despite surveillance. As a result, a well-informed patient with nondysplastic Barrett's esophagus may reasonably choose not to undergo surveillance despite endorsement of the practice by gastrointestinal societies. The discussion of the risks and benefits of surveillance should be well documented in the patient's medical record, particularly if the patient elects not to undergo surveillance. If surveillance is performed, it is important to treat erosive esophagitis prior to obtaining biopsies.

●No dysplasia – If the initial biopsies show no dysplasia, we discuss the potential risks and benefits of regular endoscopic surveillance with the patient. The length of the nondysplastic Barrett's segment generally informs surveillance intervals, and this approach is supported by society guidelines. Patients with longer segments (≥3 cm) undergo surveillance every three years, whereas patients with shorter segments (<3 cm) undergo surveillance every five years.  

●Indefinite for dysplasia – If the initial biopsies are indefinite for dysplasia, we recommend optimizing medical antireflux therapy (e.g., prescribing a proton pump inhibitor [PPI] twice daily, ensuring compliance with PPI therapy, ensuring that the PPI is taken correctly). Antireflux therapy minimizes reactive esophageal changes due to reflux esophagitis that may be mistaken for dysplastic changes. After antireflux therapy has been optimized, we repeat an endoscopy with biopsy specimens taken every 1 cm. We typically perform the endoscopy after two months of treatment (to allow sufficient time for healing). Repeat endoscopy should not be delayed beyond six months. Any mucosal irregularities should be removed with endoscopic resection.

If the repeat biopsies still are indefinite for dysplasia, the diagnosis should be confirmed by a pathologist with expertise in esophageal histopathology. If the diagnosis is confirmed, management options include surveillance endoscopy every 12 months or referral of the patient to a center with expertise in managing patients with Barrett's esophagus.

●Low-grade dysplasia, high-grade dysplasia, or intramucosal carcinoma – If the biopsies show dysplasia or intramucosal carcinoma, we suggest that the diagnosis be confirmed by another pathologist with expertise in Barrett's esophagus-related neoplasia. Endoscopy should be repeated as soon as feasible if four-quadrant biopsy specimens were not obtained at 1 cm intervals or if there were any mucosal irregularities that were not removed with endoscopic resection. Endoscopists who do not perform endoscopic resection should refer patients with mucosal irregularities to specialty centers for that procedure prior to proceeding with endoscopic eradication therapy. Endoscopic resection of mucosal irregularities is required to accurately assess the grade of dysplasia.

We generally recommend endoscopic eradication therapy for patients who are confirmed to have high-grade dysplasia or intramucosal carcinoma, and who have no evidence of submucosal invasion in their resected specimens. (See 'High-grade dysplasia or intramucosal carcinoma' below.)

Some guidelines recommend either surveillance or endoscopic eradication for patients with low-grade dysplasia [4,7,9]. In patients who elect to undergo endoscopic eradication, endoscopic radiofrequency ablation is preferable for preventing progression of dysplasia. If endoscopic surveillance is the chosen approach for low-grade dysplasia, patients should have biopsies obtained every 1 cm, any mucosal irregularities should be removed with endoscopic resection, and surveillance should be performed every 6 months for one year and then annually until there is reversion to nondysplastic Barrett's [8]. (See 'Low-grade dysplasia' below.)

Efficacy of surveillance — Observational studies suggest that surveillance can detect curable dysplasia in Barrett's esophagus and that asymptomatic cancers discovered during surveillance are less advanced than those found in patients who present with symptoms such as dysphagia or weight loss [73-79]. However, these studies are susceptible to biases such as lead-time bias and length-time bias. (See "Evidence-based approach to prevention", section on 'Special biases'.)

Findings that call into question the value of surveillance include:

●Documented development of incurable malignancies in patients who were adherent to endoscopic surveillance programs [73,74].

●A case-control study with 70 cases and 101 controls that found that patients with esophageal cancer in the setting of Barrett's esophagus were as likely to have undergone endoscopic surveillance as patients with Barrett's esophagus but no cancer [80].

A multicenter randomized trial is being conducted to look at whether endoscopic surveillance every two years influences outcomes such as overall survival, cancer-specific survival, and stage at diagnosis of esophageal adenocarcinoma in patients with nondysplastic Barrett's esophagus or Barrett's esophagus with low-grade dysplasia [81].

Surveillance techniques — The endoscopic surveillance of Barrett's esophagus should include a careful inspection of the Barrett's epithelium with high-resolution white light endoscopy and with chromoendoscopy (including virtual chromoendoscopy). Adequate time should be spent inspecting the Barrett's esophagus segment and the gastric cardia in retroflexion. Any visible abnormalities should be removed with endoscopic resection. In addition, random four-quadrant biopsies should be obtained every 2 cm (every 1 cm in patients with known or suspected dysplasia). This biopsy protocol is referred to as the Seattle biopsy sampling protocol [6].

Dysplasia in Barrett's esophagus is often patchy in extent and severity, and dysplastic areas can easily be missed because of biopsy sampling error [82-85]. Careful inspection of the metaplastic area and extensive biopsy sampling can reduce sampling error but cannot eliminate the problem entirely [86-88]. In addition, even when dysplasia is detected, foci of invasive cancer can be missed. In a meta-analysis of studies with patients who had esophagectomies for high-grade dysplasia with no apparent tumor mass, 13 percent of the resection specimens had invasive cancer [84]. In a subsequent study of 68 patients undergoing esophagectomy for high-grade dysplasia, 12 patients (18 percent) had adenocarcinoma detected in the resected esophagus [85]. Four of the cancers were intramucosal, and eight were invasive (extending into the submucosa).

Several advanced endoscopic techniques have been proposed to enhance the identification of dysplastic areas for biopsy sampling [89-94]. These techniques include mucosal staining with vital dyes (chromoendoscopy), endosonography, optical coherence tomography, confocal endomicroscopy, and virtual chromoendoscopy using narrow band imaging (NBI) or a similar technique. Some society guidelines recommend routine use of advanced imaging techniques such as chromoendoscopy, including virtual chromoendoscopy [6]. (See "Chromoendoscopy" and "Barrett's esophagus: Evaluation with optical chromoscopy" and "Confocal laser endomicroscopy and endocytoscopy", section on 'Barrett's esophagus'.)

A meta-analysis of 14 studies with a total of 843 patients examined whether advanced imaging techniques can increase the detection of dysplasia or cancer relative to white light endoscopy with random biopsies [95]. The investigators found that advanced imaging techniques increased the diagnostic yield for dysplasia or cancer by 34 percent (95% CI 20 to 56 percent). The increase in yield was similar for chromoendoscopy and virtual chromoendoscopy (eg, NBI). However, whether this increase in diagnostic yield leads to improved patient outcomes is unclear.  

Wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS-3D) has been proposed as a method to improve the detection of dysplasia during endoscopic surveillance of Barrett's esophagus, and the use of WATS-3D (in addition to Seattle protocol biopsy sampling) for surveillance is supported by some guidelines [6]. WATS-3D involves abrasive brushing of Barrett's metaplasia followed by computerized neural network analysis of the brush specimen to identify neoplasia. In a study of 160 patients with Barrett's metaplasia undergoing surveillance endoscopy, the detection rate for high-grade dysplasia (HGD)/adenocarcinoma (EAC) was higher with WATS-3D combined with biopsy sampling compared with biopsy sampling alone (18 versus 4 percent; absolute difference 14 percent, 95% CI 8-21) [96]. Of note, one case of HGD/EAC was missed in the group with WATS-3D combined with biopsy sampling, whereas 23 cases of HGD/EAC were missed by biopsy sampling alone. In another study of 12,899 patients undergoing endoscopies in which both standard forceps biopsies and WATS samples were taken, forceps biopsies identified dysplasia in 88 patients, while WATS identified an additional 213 cases of dysplasia, increasing the dysplasia detection rate from 0.68 to 2.33 percent [97]. 

A number of molecular markers for cancer risk have been proposed as alternatives to random biopsy sampling to detect dysplasia in Barrett's esophagus [98-101]. Promising molecular markers that have been associated with carcinogenesis in Barrett's esophagus include abnormalities in p53 and cyclin D1 expression, and abnormal cellular DNA content demonstrable by flow cytometry or methylation arrays. Additional evaluation of the markers is needed before they can be recommended for routine clinical use or to replace random biopsies [7]. However, some markers may serve as an adjunct to established diagnostic methods. For example, the British Society of Gastroenterology suggests that immunostaining of esophageal biopsies for p53 may improve the reproducibility of a diagnosis of dysplasia.

[p0is0ngirlx]

just got done with my billionth endoscopy over the course of my life so far. currently in bed relaxing now with a swollen & irritated esophagus. everything went well though, and surprisingly this time i somehow don’t even have a blister on my lip from it😂 the anesthesia they use to sedate me always makes me feel so emotional after. thinking about so much right now even in the hazy state i’m in. the photo next to the pic of me is a photo of kurt cobain post endoscopy. one of my greatest heroes. kurt suffered from a stomach condition, and although he didn’t have the same illness as me, i’ve always related to him so much in that aspect. i’m truly thankful that kurt has brought so much healing to my soul over the years through his art. ✨ it’s hard to be someone who is such a mess all the time, my body constantly fighting against me. today before my procedure, my doctor spoke to me about how if i don’t get some relief soon from the esophageal dilation and new stomach acid medication, i could definitely be looking at traveling to a specialist & having another huge operation done..something i have always wondered if i would ever hear again. and then it hit. and it hit hard when i heard the words. because suddenly i was a scared 10 year old girl again..hearing that she needed a big operation to be able to have any quality of life. i have always feared going through the hell of what i went through again. being on a morphine pump for days, in and out of consciousness and writhing in pain when i wasn’t severely fucked up. that operation changed me, and the fear of hearing i may have to go through it again is very real and unsettling. i am so thankful for the health i do have..i try to count my blessings every single day on this planet. all of us are going through something, this is just a part of my story..✨

[plague-parade]

time for my monthly battle with insurance over fucking omeprazole

[chronic-gastro-illness-culture]

Intro

Welcome to chronic-gastro-illness-culture. This blog is a safe space for people with chronic gastro illness to vent about symptoms of their chronic gastro illness anonymously since there’s so much shame and a sense of ‘taboo’ surrounding any ‘bathroom talk’, even though things like chronic cramping, bloating, constipation, diarrhea, heartburn, etc can be very debilitating. This is a space to build a community without feeling ashamed or gross about what you’re going through.

About

Chronic gastro illness includes: dysphasia, gastroparisis, stomach ulcers, delayed stomach emptying, GERD, Barrett’s esophagus, IBD, IBS, Crohnn’s Disease, Celiac Disease, food intolerances, food allergies, cancers of the digestive system (from mouth to rectum) and any other disorder or disease of the digestive system (from mouth to rectum) that cause distress in regards to eating, digestion, and expelling.

Rules

✅ SAFE FOR EMETOPHOBICS

⚠️ Censor the following in your ask: nausea (n*), vomit/ing (v*), throw/ing up (t*u*), puke/ing (p*). Thank you for your cooperation.

⚠️ ‘unsanitary’ and other words denoting that natural human processes are gross will not be tagged as I feel this will further internalized stigma and shame about the way society views natural digestive and expelling processes as ‘gross’ ‘shameful’ and ‘taboo’.

⚠️ I won’t use tone tags. I have blunt affect and flat affect. Deal with it.

🚫 AutoBlock: transid/transabled, radqueers/rq/🍓🌈, pwHPD, munchausen syndrome/factitious disorder || why

Info

Wolf he/him (adult) and Many they/them (adult).

Related Blogs

@ibs-culture-is

[kaelatargaryen]

Funny and dumb. Trigger warning, maybe? I’m gunna talk about weed.

Chronic illness is hard and yesterday was really hard, I have Barrett’s Esophagus due to pain management medications I took for endometriosis, they destroyed my stomach and my esophageal sphincter doesn’t close anymore so even water causes extreme heart burn. I hate depending on medication and I forgot to take my meds before work, a couple hours in and I was miserable so I had to leave work to go home and get my meds in order to eat without being sick. I’ve been in a funk lately about depending on medication anyway so this really just set me off, I cried alot of angry and mournful tears. So last night, after work, I got super high. I ate an edible (that my company made) and smoked before I fell asleep on tumblr. I didn’t think much of it when I woke up at 4 am on a page that wasn’t the one I knew I was looking at before snoozing.

Either in sleep or half asleep, I unfollowed and even blocked some folks, crossing all my god damn fingers that I didn’t report anyone too. I feel like that one is a little more involved so 🤞🏼

If you’ve gotten a follow notification from me this morning and are like??? That’s why. I unfollowed and/or blocked you whilst high. Good news is, I don’t normally get that high, I just had a face headache from crying, no appetite and I don’t work on Friday’s so I really went for it. Thankful it was brought to my attention before y’all thought I was being petty and/or didn’t wanna fuck with y’all anymore. For reasons above, y’all help me deal sometimes and I would be sad to see any of y’all go.

🫶🏼

I’m not changing it but holy fuck, proofreading and I really said y’all that many times. It’s the southern Midwest in me and that’ll never change

[sixtyseventimes]

So, an update on my stupid life. I have chronic nerve pain in my hands and feet and trying to figure out what’s causing it.

On top of that I was diagnosed with Barrett’s esophagus. There’s a high risk for esophageal cancer with that and they found a mass so now I need a biopsy of the mass to hopefully rule out cancer. If it is cancer, then idk.. I’m scared.

But yay, that’s my life. 😕

[drsamratjankar12]

Learn about the most common esophageal conditions, including heartburn-causing GERD, difficulty swallowing (dysphagia), and even esophageal cancer. Find out the causes, symptoms, and treatment options for a healthy esophagus.

[kaizenhospitals]

What is Esophagus cancer? 

Esophageal cancer develops in the esophagus, the muscular tube that carries food from the mouth to the stomach. It often begins in the cells lining the esophagus and can spread to other parts of the body as it advances. Symptoms might include difficulty swallowing, chest pain, weight loss, and heartburn. 

[kaizengastrocare]

Understand Barrett's Esophagus, a precancerous condition caused by chronic acid reflux, and learn how to manage it effectively. Kaizen Gastro Care provides comprehensive information on symptoms, diagnosis, treatment, and prevention.

https://www.kaizengastrocare.com/barretts-esophagus-what-you-need-to-know-about-this-precancerous-condition/

[familydocblog]

Tame the Flame: Beat GERD with Lifestyle Changes

Get the inside scoop on taming heartburn without meds and cooking up a GERD-friendly diet so you can say buh-bye to the burn. Read on for lifestyle tips to banish reflux, plus healthy AND delicious recipes to stop stomach acid in its tracks.

Learn about the causes, symptoms, diagnosis, and treatment options for gastroesophageal reflux disease (GERD). Discover how to manage and prevent this common condition. Photo by Towfiqu barbhuiya on Pexels.com Introduction If you’ve been diagnosed with gastroesophageal reflux disease (GERD), you know how uncomfortable the burning chest pain and regurgitation can be. While medication is often…

[wellhealthhub]

How do you calm acid reflux at night?

In the realm of digestive discomfort, one common ailment stands out: acid reflux, often identified as gastroesophageal reflux disease (GERD). This pervasive condition disrupts the harmony of nighttime repose, intertwining with our sleep and overall well-being. Herein lies a comprehensive expedition into the art of quelling acid reflux during the nocturnal hours, bestowing upon you the gift of…

[wetslug]

especially frustrating bc ive posted about problems w my diet and unintended weight gain and i get well-intended people going 'noo ur beautiful how u are' or 'dont fall into diet culture eat what u want' i dont think u understand i will eat for sensory stimuli and get horrible acid reflux and stomach pain bc i have no intuition

we need to start a club for ND people who overeat instead of forget to eat. yes i cant recognize hunger signals so i eat regardless for funsies and only realize i wasnt actually hungry when i get sick

[lifblogs]

Happy Disability Pride Month to

The GI issues! No one wants to talk about GI issues, but here we go! Some of them are:

Celiac Disease

Lactose Intolerance

Crohn’s Disease

Irritable Bowel Syndrome

Gastroesophageal Reflux Disease

Barrett’s Esophagus

Colon Polyps

Cyclic Vomiting Syndrome

Diverticulitis

Dumping Syndrome

Exocrine Pancreatic Insufficiency

Gastroparesis

Intestinal Pseudo-Obstruction

Microscopic Colitis

Stomach Ulcers

Ulcerative Colitis

Zollinger-Ellison Syndrome

If it seems like most of these were found on a list somewhere, you are correct, but I read up on every condition.

I invite anyone to use this post to discuss their own GI issues, and to add ones I have missed. Let’s get people talking about this! And let’s take stomach aches seriously. Many people go undiagnosed for a long time because of how abdominal pain and symptoms are brushed off. It’s important to listen to what you’re body is telling you, and to seek out help as soon as you can if it’s telling you it’s not feeling good. And going to a GI specialist can feel weird because who even wants to discuss excrement issues and vomiting? But come on, let’s do it. It’s okay to not feel well with your GI tract, and you’re not gross for it.

(A video I wanted to add to this post, but thought it would ruin the tone.)

[boringkate]

There's a medical condition called Barrett's esophagus (thought to be caused by acid reflux) where the lining of your esophagus changes to resemble that of intestines.

THRUSSY (by which I mean throat bussy and not throat pussy) IS REAL!!!

[stinetoftdk]

Over the last years, I've had a lot of issues. In 2022 I begun my journey towards starting a print on demand business, as I've always had flair for designing patterns and I wanted to see if it could become my ticket towards earning towards gender affirmative surgical treatment.

Late 2022, I got the news that I had been afflicted with a pre-cancerous esophageal condition, called Barrett's esophagus.

To treat my condition, apart from an increase in medication, I also had to change my diet.

I have an eating disorder, called bulimia and had it under control. I was fully recovered and had avoided disordered eating behavior, for many years in spite of having to loose weight for bottom surgery.

After having to change diet and restrict food groups, it triggered my bulimia and I haven't been able to regain control.

At the start of 2023, I had a change to my hormone treatment. My testosterone level was reduced to zero, which made me feel more at ease and not so riled up, all time. It was a change I welcomed.

At the same time something happened, that I hadn't expected.

I was of the assumption, that I had experienced all the changed that was possible on feminizing hormone treatment.

Nope.

When people with functional hormonal systems (males and females) go through puberty, apart from developing primary and secondary sex characteristics, they go through neurological changes too, making them act differently than they did before puberty.

Apparently, because my body never produced an adequate amount of sex hormones, to go all the way through a puberty (my body entered female puberty, but stopped developing pretty fast) and because my hormone treatment, has been... questionable, my brain never started puberty dependent neurological development.

This meant, that when my testosterone got lowered, I essentially entered neurological puberty... At the age of 37.

Although it might actually be a good thing to go through, it's also an emotional rollercoaster, like nothing I've ever experienced and I can see why trans people, who "get's to" go through this twice, is having such a hard time. Jeez!

To be continued...

[bunnywip]

𝘼-𝙕 𝙇𝙄𝙎𝙏 𝙊𝙁 𝘿𝙄𝙎𝙀𝘼𝙎𝙀𝙎/𝙄𝙇𝙇𝙉𝙀𝙎𝙎𝙀𝙎 𝙁𝙊𝙍 𝙎𝙄𝘾𝙆𝙁𝙄𝘾/𝙒𝙃𝙐𝙈𝙋

— A

Anemia.

Adenomyosis.

Asthma.

Arterial thrombosis.

Allergies.

Anxiety.

Angel toxicosis ( fictional ).

Acne.

Anorexia nervosa.

Anthrax.

Atma virus ( fictional ).

ADHD.

Agoraphobia.

Astrocytoma.

AIDS.

— B

Breast cancer.

Bunions.

Borderline personality disorder.

Botulism.

Barrett's esophagus.

Bowel polyps.

Brucellosis.

Bipolar disorder.

Bronchitis.

Bacterial vaginosis.

Binge eating disorder.

— C

Crohn's disease.

Conjunctivitis.

Coronavirus disease.

Coeliac disease.

Chronic migranes.

Coup.

Cushing syndrome.

Cystic fibrosis.

Cellulitis.

Coma.

Cooties  ( fictional ).

COPD.

Chickenpox.

Cholera.

Cerebral palsy.

Chlamydia.

Constipation.

Cancer.

Common cold.

Chronic pain.

— D

Diabetes.

Dyslexia.

Dissociative identify disorder.

Dengue fever.

Delirium.

Deep vein thrombosis.

Dementia.

Dysthimia.

Diphtheria.

Diarrhoea.

Disruptive mood dysregulation disorder.

Dyspraxia.

Dehydration.

— E

Ebola.

Endometriosis.

Epilepsy.

E-coli.

Ectopic pregnancy.

Enuresis.

Erectile dysfunction.

Exzema.

— F

Fusobacterium infection.

Filariasis.

Fibromyalgia.

Fascioliasis.

Fever.

Food poisoning.

Fatal familial insomnia.

— G

Gonorrhoea.

Ganser syndrome.

Gas gangrene.

Giardiasis.

Gastroesophageal reflux disease.

Gall stones.

Glandular fever.

Greyscale ( fictional ).

Glanders.

— H

Hookworm infection.

Hand, foot and mouth disease.

Hypoglycaemia.

Herpes.

Headache.

Hanahaki disease ( fictional ).

Hyperhidrosis.

Heat stroke.

Heat exhaustion.

Heart failure.

High blood pressure.

Human papillomavirus infection.

Hypersomnia.

HIV.

Heart failure.

Hay fever.

Hepatitis.

Hemorrhoids.

— I

Influenza.

Iron deficiency anemia.

Indigestion.

Inflammatory bowel disease.

Insomnia.

Irritable bowel syndrome.

Intercranial hypertension.

Impetigo.

— K

Keratitis.

Kidney stones.

Kidney infection.

Kawasaki disease.

Kaposi's sarcoma.

— L

Lyme disease.

Lassa fever.

Low blood pressure.

Lupus.

Lactose intolerance.

Lymphatic filariasis.

Leprosy.

— M

Measles.

Mad cow disease.

Mumps.

Major depressive disorder.

Malaria.

Malnutrition.

Motor neurone disease.

Mutism.

Mouth ulcer.

Monkeypox.

Multiple sclerosis.

Meningitis.

Menopause.

Mycetoma.

— N

Norovirus.

Nipah virus infection.

Narcolepsy.

Nosebleed.

Nocardiosis.

— O

Obsessive-compulsive disorder.

Osteoporosis.

Ovarian cyst.

Overactive thyroid.

Oral thrush.

Otitis externa.

— P

Pancreatic cancer.

Pneumonia.

Pelvic inflammatory disease.

PICA.

Premenstrual dysphoric disorder.

Psoriasis.

Parkinson's disease.

Panic disorder.

Polycystic ovarian syndrome.

Plague.

Postpartum depression.

Pediculosis capitis.

Psychosis.

Post-traumatic stress disorder.

— Q

Q fever.

Quintan fever.

— R

Rubella.

Rabbit fever.

Rotavirus infection.

Ringworm.

Restless legs syndrome.

Rhinovirus infection.

Rosacea.

Relapsing fever.

Rheumatoid arthritis.

Rabies.

— S

Shingles.

Sore throat.

Stutter.

Separation anxiety disorder.

Smallpox.

Scoliosis.

Septic shock.

Shigellosis.

Sepsis.

Social anxiety disorder.

Stroke.

Scarlet fever.

Schizophrenia.

Sleep apnea.

Sun burn.

Syphilis.

Sickle cell disease.

Scabies.

Selective mutism.

Salmonella.

Sensory processing disorder.

— T

Thyroid cancer.

Tuberculosis.

Thirst.

Trichuriasis.

Tinea pedis.

Tourette's syndrome.

Trachoma.

Tetanus.

Toxic shock syndrome.

Tinnitus.

Thyroid disease.

Typhus fever.

Tonsillitis.

Thrush.

— U

Urinary tract infection.

Underactive thyroid.

— V

Valley fever.

Vertigo.

Vomiting.

— W

White piedra.

Withdrawal.

Whooping cough.

West nile fever.

— X

Xerophthalmia.

— Y

Yersiniosis.

Yellow fever.

— Z

Zygomycosis.

Zika fever.

Zeaspora.