Q: My brother has had severe pain, shortness of breath, and acid reflux. He has been diagnosed with Barrett’s and is concerned with the irritation in his esophagus. He has changed his diet, dropped about 25 pounds so far and has taken medication – all to no avail. The pain is so severe that he is unable to work. His doctors have recommended gastric bypass surgery to help with this. This is major surgery and I’d like your input if this is beneficial for people suffering from acid reflux. Please advise if possible and thanks for your time.
A: The exact cause of Barrett’s esophagus is unknown; however, chronic gastroesophageal reflux disease (GERD) is a known risk factor for the condition and those with Barrett’s are at an increased risk of developing a rare type of cancer known as esophageal adenocarcinoma. GERD is more serious and a long-lasting form of gastroesophageal reflux, a condition in which the contents of the stomach flow back into the esophagus.
Barrett’s is a disorder in which the lining of the esophagus, the tube that carries food from the mouth to the stomach, is damaged because of a backward flow of stomach acid. During the process of eating, food passes from the throat to the stomach through the esophagus. Once food reaches the stomach, a ring of muscles keeps it from propelling backward. However, when the ring of muscles fail to close tightly, stomach acid can leak back into the esophagus, causing esophageal reflux and damage to the esophageal lining. A burning mid-chest feeling known as acid indigestion results.
Diagnosis can be made by a gastroenterologist performing an endoscopy that utilizes a thin tube with a camera on the end that is passed from the mouth to the esophagus and on to the stomach. The camera will assist the physician to view and ultimately biopsy questionable areas of the esophagus during the procedure. There are distinct patterns he or she will look for but sometimes changes can only be seen through a microscope, making diagnosis difficult at times. Surgery may be recommended if the biopsy reveals cell changes that are likely to lead to cancer and may utilize a special laser device or other high energy procedures that will destroy the precancerous tissue.
Treatment to reduce symptoms may begin with the patient making dietary modifications including a high intake of fruits, vegetables and vitamins and taking an antacid following meals and at bedtime. Caffeine, alcohol, tobacco and carbonated beverages should be avoided. The head of the bed should be elevated to reduce the occurrence of reflux. Individuals who are overweight may improve with a weight reduction program. If these steps fail to reduce symptoms, a physician may prescribe histamine H2 receptor blockers or proton pump inhibitors. For those with high-grade dysplasia, management is somewhat controversial. Options include removal of portions of the esophagus and removing or destroying the abnormal tissue by using endoscopic techniques. Ablative therapies may be performed by a radiologist, a physician who specializes in medical imaging. The procedures most frequently used are photodynamic therapy and radiofrequency ablation. The first utilizes a light-activated chemical, endoscope and a laser to kill precancerous cells in the esophagus. The latter utilizes radio frequency energy to kill any precancerous or cancerous cells.
There are claims that gastric bypass surgery can cure GERD because the very small upper stomach created during the procedure has very few cells that can produce acid. The acid producing portion of the stomach is disconnected from the esophagus, allowing GERD symptoms to dissipate and gives the esophagus time to heal, thus stopping the ongoing chronic injury caused by acid reflux. You do indicate your brother lost 25 pounds but didn’t state he was grossly overweight. While not a gastroenterologist, from what I have read, gastric bypass might be effective on those individuals that are obese. Therefore, I cannot comment on whether the procedure is in your brother’s best interests. Perhaps a second opinion that will reveal his full medical history, degree of pain experienced, age and general condition will provide the information necessary to make this decision. Good luck.
