New Treatments for GERD and Barrett's Esophagus


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Learn the symptoms of Gastroesophageal Reflux Disease (GERD) and Barrett’s esophagus, and when they may warrant further medical attention. Hear the latest in treatment methods, including radio frequency ablation and endoscopic ultrasound.

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  • Prevalence western country 10-20%, less in Asia, 7% of population may need long tern medication Mild one episode per week Severe >3 per week
  • Heal 50 % of mild cases of erosive esophagitis
  • New Treatments for GERD and Barrett's Esophagus

    1. 1. Gastroesophgeal Reflux Disease (GERD) Hazar Michael, M.D. June 14, 2012
    2. 2. GERD Overview• Reflux occurs when the stomach contents reflux or back up into the esophagus and/or mouth.  Reflux is a normal process that occurs in healthy individuals  Most episodes are brief and do not cause symptoms or complications  Mostly after meals, rarely at night  Results from transient relaxation of the muscle sphincter in lower esophagus• People with GERD experience symptoms or complications as a result of the reflux
    3. 3. GERD is a Common Problem 80 Males Females 60Prevalence (%) Any episode of GERD symptoms 40 At least weekly 20 episodes of GERD symptoms 0 25–34 35–44 45–54 55–64 65–74 Age (years) Locke et al. Gastroenterology 1997
    4. 4. Symptoms of GERD• Typical symptoms  Pain in the upper abdomen  Burning chest pain  Food getting stuck (dysphagia)  Pain upon swallowing (odynophagia)  Taste of acid or food in throat or food or fluid coming up without effort (regurgitation)• Atypical symptoms  Persistent sore throat  Sense of a lump in the throat  Waking up with a choking sensation
    5. 5. Symptoms of GERD• Atypical symptoms continue  Persistent laryngitis/hoarseness  Chronic cough, new onset asthma, or asthma only at night  Worsening dental disease  Recurrent Pneumonia  Chronic sinusitis
    6. 6. Natural History of GERD• Majority of patients do very well and only require symptom control• Minority will develop serious complications
    7. 7. Potential Complications of GERD• Severe esophageal inflammation and esophageal ulcer formation• Esophageal stricture formation (narrowing diameter)• Barrett’s esophagus• Esophageal cancer• Hoarseness• Pneumonia which if frequent may lead to permanent lung damage
    8. 8. Barrett’s Esophagus • Changing in the lining of the esophagus to become intestine like lining • Exact number of effected individual is unknown  Overall 1.6% • 1.4% no GERD symptoms • 2.3% with GERD symptoms  Risks factors • Male • Caucasian • Smoking • Hiatal hernia • Increased visceral fat depositionRonkainen J, et al. Prevalence of Barretts esophagus in the general population: an endoscopic study. Gastroenterology.2005;129:1825-31.Bonino JA. Barret’s esophagus. Current opinion in gastroenterology 2006,22:406-411
    9. 9. Barrett’s Esophagus and Esophageal Cancer• The exact increase risk is unclear  Increased risk by 30-125 folds • Esophageal cancer is uncommon  Life time risk of developing esophageal cancer 0.4-0.5 per 100 patients per year • 1% per year in LGD • 10% per year in HGD• Risk to progress to HGD is 0.9 per year• Likely progression from Barrett’s LGD HGD Ad Ca  ~18% in LGD  ~ 34% HGD
    10. 10. Surveillance for Barrett’s Esophagus• Not clear if useful but usually recommended• At first endoscopy perform extensive biopsy  No dysplasia, confirmed by second endoscopy within 1 year → EGD in 3-5 years  LGD EGD in 1 year vs. treatment  HGD In individual with reasonable life expectancy consider treatment
    11. 11. Treatment of Barrett’s Esophagus• Control acid and inflammation usually by medication• Eradication of Barrett’ tissue by heat or cold or other methods• Removal of early cancer endoscopically• For advanced cancer either surgery or chemotherapy and radiation therapy
    12. 12. HALO Device (Barrx Device)• A device delivers heat to get rid of Barrett’s tissue• Usually recommended for patients with dysplasia and few selected patients without dysplasia  About 90% chance of eliminating dysplasia and Barrett’s esophagus and at least tow fold decrease in cancer risk  Durable at 5 years but no longer term data
    13. 13. When Do I Need to Seek Medical Care?• Symptoms are getting worse or inability to control them• When you are in doubt if something wrong• Need to seek immediate medical care • Trouble swallowing/chocking or sensation of food being stuck or lump in throat • Unintentional weight loss  Chest pain  Vomiting blood or having bowel movements that are black or look like tar
    14. 14. Diagnosing GERD• Clinical by history and therapeutic trial• Endoscopy• PH testing• Esophageal manometry• Radiology
    15. 15. Treatment of GERD• Life style modification• Medications• Endoscopic procedure• Surgery
    16. 16. Life Style modificationNot clear if it is effective but usually recommended• Lose weight (if you are overweight)• Raise the head of your bed by 6 to 8 inches• Avoid foods that make your symptoms worse • Coffee, chocolate, alcohol, peppermint, and fatty foods• Cut down on the amount of alcohol you drink• Stop smoking• Frequent small meal, avoid overeating• Eat a bunch of small meals each day• Avoid lying down for 3 hours after a meal
    17. 17. Dietary factors that may aggravate GERD symptoms• Caffeinated • Spicy foods products • Citrus fruits and• Peppermint juices• Fatty foods • Tomato-based• Chocolate products • Alcohol
    18. 18. Medications• Antacids work for mild infrequent episodes of GERD or as adjuvant to other medication in more severe case• Antihistamine work in mild GERD and not very effective to heal severe esophageal inflammation
    19. 19. Medications• PPI as class are the strongest medication  Heal inflammation over 80%  Most work better if taken before meals  Usually once a day and occasionally twice a day  For symptoms control only initial treatment is 8 weeks • If symptoms relapse within 3 months usually are needed for long term  Goal of therapy is to use the lowest effective dose of medication  Usually safe but can lead to decrease bone dentistry and nutrient absorption and increase risk of infections especially clostridium difficile
    20. 20. My Medications Are Not Working What Should I Do ?• If PPI, are you taking it before meal?• Change to different PPI• PPI twice a day• Additional testing• Consideration for surgery
    21. 21. Surgery for GERD• Goal to increase barrier to acid reflux with minimal impact on the ability to swallow• Surgery plays an important role in patients with large hiatus hernia and those unable or unwilling to take long term medications• Majority are done laparoscopically, result depends on surgeon experience• Potential complications  Difficulty swallowing (5%)  Sense of bloating and gas  Breakdown of the repair (1 to 2 percent of patients per year)  Diarrhea due to inadvertent injury to the nerves
    22. 22. Summary• GERD is common and in a majority of cases has benign course• Use lowest effective dose of medication• Trouble swallowing, chest pain or bleeding seek immediate attention• Barrett’s esophagus in a majority of cases does not lead to cancer, but keeping an eye on it is advisable
    23. 23. For more information Call (908) 273.4300Visit: Connect with us on Facebook/SummitMedicalNJ Twitter: @SummitMedicalNJ