Barrett's Esophagus?

Dear “Caradavin”

Having read your “about me” page, I can see why you are wondering what is going on with the “EGD”.  You didn’t tell us if you were having any of the symptoms of Barrett’s Esophagus.  If you had elaborated on the reasons why an EGD was performed, that would have given us a clue.  We’re all familiar with suspicious symptoms.  It would seem to me that your physician would have discussed the findings right after the test.  In my husband’s case, we were not told to wait and discuss anything with the gastroenterologist.  So we went home after the procedure.  But the very next day, Dr. Ryan called to say, “I do wish you had stayed around yesterday.  I needed to talk with you.  Your husband has cancer!” 

 So because of our own experience with our gastroenterologist, it would only seem logical that the results of the test would have been shared with you.  After all, you’re the patient, and to be made to “WAIT” for a period of time.  However, on the other hand, in listening to reference #6 below, the doctor is saying that while an endoscopy can “suggest” the presence of Barrett’s Esophagus that actually only a “biopsy” can confirm Barrett’s for sure.  So it might be that a biopsy was performed when your EGD was conducted.  If so, that may be the reason for a follow-up to discuss the results of your test.  However, in my husband’s case, the endoscopy indicated Esophageal Cancer immediately.  Of course, following this initial discovery, there were multiple tests to determine the extent of his cancer and determination of the course of action for proper reatment. 

But for the time being, I, for one, cannot give you a definitive answer to your question.  However, we have members of my immediate family that do have frequent heartburn and acid reflux.  Although their physicians have only recommended “Omeprazole”,(PPI), we question that as the “solution.”  Often people have been prescribed NEXIUM for instance for heartburn, when in fact it only masked the true problem.  Many who finally go to the doctor for difficulty swallowing and excessive heartburn present with an advanced stage of Esophageal Cancer.  So be certain that you understand all the report results once you have that consultation. 

Obviously, of all the possibilities that Barrett’s might lead to, we certainly hope that Esophageal Cancer is NOT one of them.

Sincerely,

Loretta (Wife of William DX w/Adenocarcinoma @ the Gastroesophageal Junction (GE), neo-adjuvant chemo/radiation treatment then an Ivor Lewis Minimally Invasive Esophagectomy by Dr. James D. Luketich at University of Pittsburgh Medical Center on May 17, 2003 and now into Year 15 with no recurrence—thank God!)

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1.       https://www.healthline.com/health/egd-esophagogastroduodenoscopy#overview1

EGD Test (Esophagogastroduodenoscopy)

• Purpose --Preparation --  Procedure --   Results  -- After the test

 What is an EGD test?

Your doctor performs an esophagogastroduodenoscopy (EGD) to examine the lining of your esophagus, stomach, and duodenum. The esophagus is the muscular tube that connects your throat to your stomach and the duodenum, which is the upper part of your small intestine.

An endoscope is a small camera on a tube. An EGD test involves passing an endoscope down your throat and along the length of your esophagus.

PURPOSE

Why an EGD test is performed

Your doctor may recommend an EGD test if you have certain symptoms, including:

1. severe, chronic heartburn
2. vomiting blood
3. black or tarry stools
4. regurgitating food
5. pain in your upper abdomen
6. unexplained anemia
7. persistent nausea or vomiting
8. unexplained weight loss
9. a feeling of fullness after eating less than usual
10. a feeling that food is lodged behind your breastbone
11. pain or difficulty swallowing

Your doctor may also use this test to help see how effectively a treatment is going or to track complications if you have:

• Crohn’s disease
• peptic ulcers
• cirrhosis
• swollen veins in your lower esophagus

PREPARATION

Preparing for the EGD test

Your doctor will advise you to stop taking medications such as aspirin (Bufferin) and other blood-thinning agents for several days before the EGD test.

You won’t be able to eat anything for 6 to 12 hours before the test. People who wear dentures will be asked to remove them for the test. As with all medical tests, you’ll be asked to sign an informed consent form before undergoing the procedure.

PROCEDURE

Where and how the EGD test is administered

Before administering an EGD, your doctor will likely give you a sedative and a painkiller. This prevents you from feeling any pain. Usually, people don’t even remember the test.

Your doctor may also spray a local anesthetic into your mouth to stop you from gagging or coughing as the endoscope is inserted. You’ll have to wear a mouth guard to prevent damage to your teeth or the camera.

The doctor then inserts an intravenous (IV) needle into your arm so that they may give you medications throughout the test. You’ll be asked to lie on your left side during the procedure.

Once the sedatives have taken effect, the endoscope is inserted into your esophagus and passed down into your stomach and the upper part of your small intestine. Air is then passed through the endoscope so that your doctor can clearly see the lining of your esophagus.

During the examination, the doctor might take small tissue samples using the endoscope. These samples can later be examined with a microscope to identify any abnormalities in your cells. This process is called a biopsy.

Treatments can sometimes be done during an EGD, such as widening any abnormally narrow areas of your esophagus.

The complete test lasts between 5 and 20 minutes.

Risks and complications of an EGD test

In general, an EGD is a safe procedure. There’s a very slight risk that the endoscope will cause a small hole in your esophagus, stomach, or small intestine. If a biopsy is performed, there’s also a small risk of prolonged bleeding from the site where the tissue was taken.

Some people also may have a reaction to the sedatives and painkillers used throughout the procedure. These could include:

• difficulty breathing or an inability to breathe
• low blood pressure
• slow heartbeat
• excessive sweating
• a spasm of the larynx

However, less than one out of every 1,000 people experience these complications.

RESULTS

Understanding the results

Normal results mean that the complete inner lining of your esophagus is smooth and shows no signs of the following:

• inflammation
• growths
• ulcers
• bleeding

The following may cause abnormal EGD results:

• Celiac disease results in damage to your intestinal lining and prevents it from absorbing nutrients.
• Esophageal rings are an abnormal growth of tissue that occurs where your esophagus joins your stomach.
• Esophageal varices are swollen veins within the lining of your esophagus.
• A hiatal hernia is a disorder that causes a portion of your stomach to bulge through the opening in your diaphragm.
• Esophagitis, gastritis, and duodenitis are inflammatory conditions of the lining of your esophagus, stomach, and upper small intestine, respectively.
• Gastroesophageal reflux disease (GERD) is a disorder that causes liquid or food from your stomach to leak back into your esophagus.
• Mallory-Weiss syndrome is a tear in the lining of your esophagus.
• Ulcers can be present in your stomach or small intestine.

AFTER THE TEST

What to expect after the test

A nurse will observe you for about an hour following the test to make sure that the anesthetic has worn off and you’re able to swallow without difficulty or discomfort.

You may feel slightly bloated. You may also have slight cramping or a sore throat. These side effects are quite normal and should go away completely within 24 hours. Wait to eat or drink until you can swallow comfortably. Once you do begin eating, start with a light snack.

You should seek immediate medical attention if:

• your symptoms are worse than before the test
• you have difficulty swallowing
• you feel dizzy or faint
• you’re vomiting
• you have sharp pains in your abdomen
• you have blood in your stool
• you’re unable to eat or drink
• you’re urinating less than usual or not at all

Your doctor will go over the results of the test with you. They may order more tests before they give you a diagnosis or create a treatment plan.”

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2.       https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/esophagogastroduodenoscopy_92,P07717

“What is an upper GI endoscopy?

An upper GI endoscopy or EGD (esophagogastroduodenoscopy) is a procedure to diagnose and treat problems in your upper GI (gastrointestinal) tract.

The upper GI tract includes your food pipe (esophagus), stomach, and the first part of your small intestine (the duodenum).

This procedure is done using a long, flexible tube called an endoscope. The tube has a tiny light and video camera on one end. The tube is put into your mouth and throat. Then it is slowly pushed through your esophagus and stomach, and into your duodenum. Video images from the tube are seen on a monitor.

Small tools may also be inserted into the endoscope. These tools can be used to:

• Take tissue samples for a biopsy
• Remove things such as food that may be stuck in the upper GI tract
• Inject air or fluid
• Stop bleeding
• Do procedures such as endoscopic surgery, laser therapy, or open (dilate) a narrowed area…”

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 3.        http://www.upmc.com/SERVICES/DIGESTIVE-DISORDERS-CENTER/SERVICES/GASTROINTESTINAL-CANCER-PREVENTION-TREATMENT/Pages/default.aspx

[My note:  Play the video on the sidebar to know what more UPMC does to treat Barrett’s Esophagus.]

“…Why Choose UPMC for GI Cancer Treatment?

Here is what sets the Gastrointestinal Cancer Prevention and Treatment Center apart:

  We ensure coordinated care through our collaboration with UPMC Hillman Cancer Center. By linking the expertise of our GI experts to skilled medical, surgical, and radiation oncologists, we can provide care that is tailored to your condition, no matter how complex.

 Among our team are world experts in the field of GI cancers. This ensures that you receive the highest standard of care complemented by the latest cancer treatment.§  We lead cutting-edge research that is helping to create new methods for the diagnosis, treatment, and prevention of GI cancers.

    We offer access to the Barrett's Esophagus Specialty Treatment (BEST) Clinic. This specialty clinic treats the impact that Barrett’s esophagus can have on the esophagus in order to reduce the patient’s risk of cancer.

    Our doctors employ the latest screening tools for proper diagnosis of GI cancers, such as chromoendoscopy and narrow-band imaging…”

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4.        https://www.youtube.com/watch?v=tQ6a4arjFdE

 Mayo Clinic - Published on Apr 22, 2010

With Gastroesophageal Reflux Disease, or GERD, acid splashes up into the esophagus repeatedly, which can damage the lining of the esophagus. In a process called metaplasia, damaged cells turn into a type of cell more like tissue found in the intestines. When this occurs in the esophagus, the condition is called Barretts esophagus. This video explains short segment Barretts esophagus and long segment Barretts esophagus. Mayo Clinic has a very large team with an international reputation for its skill in diagnosing and treating reflux, Barretts esophagus and esophagus cancer. For more information, go to the Mayo Clinic website, http://www.mayoclinic.org/barretts-es...

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5.        https://www.youtube.com/watch?v=EQHkbpC59mU

“FriendsofOCM - Dr. Jeff Goldman discusses treatment options for acid reflux disease, and more specifically, Barrett's Esophagus.”

 6.        https://www.youtube.com/watch?v=D1I_5YTkb7E

 [My note:  This is a 32 minute video that explains Barrett’s Esophagus.  Note the 3:05 minute marker where this doctor makes a distinction in how the Barrett’s is accurately diagnosed.  He says that Barrett’s may be “suggested” by performing the endoscopy, but it can only be confirmed by a “biopsy.”]

UCLA Health - Published on Mar 18, 2014

“UCLA Center for Esophageal Disorders Continuing Medical Education Esophageal Disorders for the Primary Care Physician Sept 18, 2013”

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