Gastric biopsy?
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Introduction
Tums. Maalox. Mylanta. Rolaids. These and other over-the-counter remedies spell "relief" for many of the millions of Americans who regularly have heartburn.
However, common heartburn isn't always just an annoying condition that's quickly remedied by an over-the-counter antacid. It can also be symptomatic of gastroesophageal reflux disease (GERD), which is the chronic regurgitation of acid from your stomach into your lower esophagus. And, long-term GERD can sometimes lead to Barrett's esophagus, a condition in which the color and composition of the cells lining your lower esophagus change because of repeated exposure to stomach acid.
Barrett's esophagus is uncommon. Only a small percentage of people with GERD develop Barrett's esophagus. But once Barrett's esophagus is diagnosed, there's a greater risk of developing esophageal cancer, which often spreads from the esophagus to lymph nodes and to other organs. Although increased, the absolute risk of esophageal cancer for someone with Barrett's esophagus is small — less than 1 percent a year.
You can eliminate or reduce the frequency of stomach acids flowing up into the lower end of your esophagus — and your chance of developing Barrett's esophagus — by making lifestyle changes.
The primary goal of Barrett's esophagus treatment is to prevent the development of esophageal cancer. It's not too late to treat dysplasia in Barrett's esophagus if it hasn't yet advanced to cancer.
Treatment for Barrett's esophagus may start with controlling GERD by making a number of lifestyle changes and taking self-care steps. These actions include losing weight, avoiding foods that aggravate heartburn, stopping smoking if you smoke, taking antacids or stronger acid blocking medications, and elevating the head of your bed to prevent reflux during sleep.
People with severe GERD and Barrett's esophagus usually need aggressive treatment, which may include medications, other nonsurgical medical procedures or even surgery.
Medications
Medications to treat GERD and Barrett's esophagus include:
Proton pump inhibitors (PPIs). These medications — such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix) and esomeprazole (Nexium) — block production of acid and relieve irritated tissue.
H-2-receptor blockers. Doctors sometimes prescribe this class of drugs to treat GERD and Barrett's esophagus. They're less expensive, although weaker than PPIs. Prescription H-2-receptor blockers such as famotidine (Pepcid), cimetidine (Tagamet), nizatidine (Axid) and ranitidine (Zantac) are also available over-the-counter in doses less than prescription strength.
Although these medications often are quite effective for GERD, once Barrett's metaplasia is present these drugs won't reliably reverse the condition, and the risk of cancer remains even if your GERD symptoms go away with treatment.
Surgery
Anti-reflux surgery (laparoscopic Nissen fundoplication) offers an alternative to dependence on medication for GERD. The procedure tightens the sphincter by wrapping part of the stomach around the lower esophagus to prevent acid reflux. Laparoscopic surgery involves inserting special instruments through small incisions — less than an inch. The procedure leaves only tiny scars. You can expect to stay in the hospital for one or two days after this surgery. Although surgery can be effective for GERD, once Barrett's metaplasia is present surgery won't reliably reverse the condition, and the risk of cancer remains.
If you have esophageal cancer, or if you have Barrett's esophagus and high-grade dysplasia, your doctor may recommend you undergo a major surgical procedure in which the esophagus is removed completely and the stomach is pulled into the chest (esophagectomy). You may need to spend about two weeks recovering in the hospital after surgery. Although this treatment is effective, it is associated with significant health risks. Up to 50 percent of people who undergo esophagectomy experience at least one serious complication, including pneumonia, heart attack and infections at the surgical site.
The surgical treatment of people with high-grade dysplasia is controversial. Some experts believe that esophagectomy should be used as a measure to protect against cancer. Other experts believe that it's sufficient to schedule screening endoscopies every three to six months and perform an esophagectomy only if cancer develops. Doctors generally don't recommend surgery for people with declining health or for those who are too weak to withstand a major procedure.
Alternatives to medications and surgery
Removal (ablation) of dysplasia makes possible the reversal of Barrett's esophagus, and it may prevent esophageal cancer. Combined with PPIs, ablation may be appropriate especially if you're not a good candidate for an esophagectomy. Ablation procedures include:
Photodynamic therapy (PDT). First, you'll be injected with a drug called porfimer sodium (Photofrin) that makes the Barrett's cells sensitive to light. Then, your doctor inserts a specialized light source into your esophagus. The light causes a reaction with the Photofrin that destroys Barrett's cells.
Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.
Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett's cells.
Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.
Endoscopic mucosal resection. Using an endoscope, your doctor injects a saline solution under the area of your esophagus that contains dysplasia. A blister forms under these abnormal cells, allowing your doctor to cut or suction the abnormal area away from the underlying tissue without damaging the rest of your esophagus. Your doctor may recommend following this procedure with photodynamic therapy.
The long-term effectiveness of ablation procedures in preventing cancer is still being studied.
This part is what the Doc thinks "suspicious for lymphoma" and could be serious or nothing if he's wrong.
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