GERD, Barret's Esophagus, & Cancer
GERD (gastroesophageal reflux disease) is extremely common. It occurs when
lower esophageal sphincter tone is reduced. The loss of LES tone allows acid reflux, which damages the lower esophagus.
Common symptoms include esophagitis with heartburn (epigastric pain that radiates to the chest, beware that it can mimic angina) and acid regurgitation, which can create a characteristic bad taste in the mouth. Some patients also have chronic cough and hoarseness from the acid reflux. Many patients are asymptomatic.
Complications: Barrett's esophagus & cancer.
Endoscopy may show erosion, ulcers, and stricture formation.
Risk factors include alcohol use and tobacco smoking.
Treatment typically relies on proton-pump inhibitors. In some cases, Nissen fundoplication is performed to surgically create a new lower esophageal sphincter.
Barrett's esophagus is a complication of GERD; it usually presents 5-10 years after GERD.
Upon examination, we'll see that the normal squamous epithelium of the esophagus is replaced by intestinal epithelium with metaplastic columnar epithelium with goblet cells.
Barrett's esophagus predisposes individuals to dysplasia and adenocarcinoma.
Esophageal cancer is characterized by progressive dysphagia and weight loss. The fact that patients first experience difficulty swallowing foods, then also liquids, is an important sign of cancer vs some other conditions.
Squamous cell carcinoma usually occurs in the upper 2/3 of the esophagus; risk factors include strictures and achalasia.
Adenocarcinoma usually occurs in the distal 1/3 of the esophagus; risk factors include GERD and Barrett esophagus. Adenocarcinoma has poor prognosis.
