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Gastroesophageal reflux disease (GERD)

Arguments for Radiofrequency Ablation (RFA; HALO®) of Barrett‘s Esophagus.

Heartburn, acid regurgitation, wheezing, cough and asthma are symptoms of Gastroesophageal reflux disease ( GERD), which affects 20% - 30% of the population (1). Due to the symptoms GERD impairs the life quality, productivity and well being of the patients. In addition, 20% t0 30% of those with GERD symptoms develop Barrett‘s esophagus (BE) (1-3).  As a consequence of the Reflux-induced tissue stress the innermost layer of the esophagus (gullet) is replaced by a columnar Epithelium with goblet cells, this is BE. Via low- (LGD) and high grade Dysplasia (HGD), BE may progress to esophageal cancer (0.5% annual cancer risk) (2,3). Thus BE shares the same cancer risk, when compared to that of a polyp in the colon (2,3).

The biological characteristics of Barrett‘s esophagus results in typical diagnostic and prognostic insecurities (1-3):

  • It is not known how long BE existed prior to the detection
  • when and if a person with BE will develop cancer
  • if more advanced tissue has been missed during Biopsy sampling ( Biopsy sampling error)
  • if pathologist missed advanced tissue during the microscopic examination (observer disagreement).

As a matter of fact, the genetics of BE are similar to cancer, the only difference: the genetic program is not yet manifest at the protein level. However, no body knows when this will occur.

All the above insecurities are eliminated by ablation of BE. Therefore we recommend radiofrequency ablation (RFA; HALO®) of BE to prevent cancer development. RFA is save, effecitve and durable (4,5), prevents cancer (4) and restores the life quality of the patients (5).

Patients at risk for cancer development are defined by:
GERD > 10 years
positive family history regarding malignant diseases (foregut, large bowel, liver, pancreas, thyroids, skin),
endoscopically visible columnar lined esophagus (CLE) > 2.0 cm
Hiatal hernia > 2.0 cm.

Recent studies proved, that RFA prevents cancer and restores the life quality (4,5).

Feel free to contact us to get information on GERD, Barrett‘s esophagus and radiofrequency ablation.

Literature

  1. Spechler SJ, Fitzgerald RC, Prasad GA, Wang KK. History, molecular mechanism, and endoscopic treatment of Barrett‘s esophagus. Gastroenterology 2010; 138(3): 854-69.
  2. Lenglinger J, Eisler M, Wrba F et al. Update: histopathology-based definition of Gastroesophageal reflux disease and Barrett‘s esophagus. Eur Surg 2008; 40/4: 165-75.
  3. Lenglinger J, Izay B, Eisler M et al. Barrett‘s esophagus: size of the problem and diagnostic value of a novel histopathology classification. Eur Surg 2009; 41/1: 26-39.
  4. Shaheen NJ, Sharma P, Overholt BF et al. Radiofrequency ablation in Barrett‘s esophagus with Dysplasia. N Engl J Med 2009; 360: 2277-88.
  5. Shaheen NJ, Peery AF, Hawes RH et al. Quality of life following radiofrequency ablation of dysplastic Barrett’s esophagus. Endoscopy 2010; 42: 790-99.
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