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Persistent chronic heartburn, a burning sensation, burning or regurgitation of food into the esophagus, and frequent vomiting, pain behind the breastbone and difficulty swallowing food should prompt us to see a doctor.
What symptoms should make us see a doctor?
Especially alarming is the situation where the above symptoms occur more than three times a week, disappear temporarily after the use of drugs that reduce gastric acid secretion, and reappear after stopping their use. It is also alarming if they have been present for a long time, a few – a dozen or even several dozen years, and they mainly concern men over 50. These are alarm symptoms and signal the need for gastroscopy, as in as many as 20% of patients. Barrett’s esophagus is present in all patients with chronic acid reflux. It is a disease of the lower esophagus considered a precancerous condition characterized by the replacement of normal esophageal epithelium with intestinal epithelium.
What causes the disease and who is most at risk of it?
Over time, damage to the esophagus by refluxing stomach acid into the esophagus causes genetic changes in cells that can develop into a malignant tumor (esophageal cancer) imperceptibly. The risk of esophageal cancer in these patients is up to 40 times higher, and in people diagnosed with Barrett’s esophagus, the probability of developing cancer is 4-7%. and increases after the age of 60. Barrett’s esophagus about 80 percent. cases may develop asymptomatically, and the first sign of neoplastic process may be difficulties in swallowing food. The diagnosis of Barrett’s esophagus is made on the basis of endoscopic examination of the esophagus and histopathological evaluation of the specimens collected during the examination.
Are the most modern methods of treating Barrett’s esophagus, e.g. Halo therapy, available in Poland? Are they reimbursed and give a chance of a full recovery?
To treat the symptoms of gastroesophageal reflux, medications are used to reduce the secretion of gastric acid, as well as medications to stop the reflux of food into the esophagus and empty the stomach (prokinetics). Pharmacological and dietary treatment, and in some cases surgical laparoscopic anti-reflux treatment, only reduces symptoms, but does not allow for the reversal of metaplastic changes in the damaged esophagus. One of the most modern for several years and more and more available therapeutic methods is the destruction (thermoablation) of the diseased metaplastic epithelium with the use of radio frequency current (the Halo method). This method is the least invasive and has no particular contraindications. During the procedure, the diseased mucosa is destroyed to a depth of 1 mm, and the deeper tissue is regenerated. This method has only recently been available in Poland, the procedures are performed in hospital conditions in short sleep during a three-day stay and is fully reimbursed by the National Health Fund. However, it is important to remember that Barrett’s esophagus is basically asymptomatic, apart from the symptoms of acid reflux disease, so you can live without knowing about it. Its existence is determined by a thorough gastroscopic examination with the evaluation of the esophagus-gastric junction and the histopathological examination of the specimens.
Bow. med. Ireneusz Marciniak, gastroenterologist-endoscopist
Vita-Med Medical Center in Gdynia, Gastromed Starogard Gdański, www.ireneuszmarciniak.pl