What are the chances that I will develop Barrett’s esophagus?
Barrett’s esophagus develops in about 10 to 20 percent of patients with chronic
GERD or inflammation of the esophagus. It occurs more often in men than in women
(3:1 ratio) and is more common in Caucasian Americans than African Americans.
The prevalence of Barrett’s esophagus increases with age; the average age at
diagnosis is 55 years
Are there any complications associated with this procedure?
Complications that may occur from a Nissen "wrap" are dysphagia (difficulty swallowing) and abdominal distention. The dysphagia is usually mild and temporary but occasionally can be severe or persistent. Another post-operative problem is the "gas bloat" syndrome, in which patients develop bloating and abdominal pain after urgery. Some degree of this syndrome is not uncommon after surgery but is usually a minor nuisance. However, "gas bloat" can be severe and difficult to treat. Three major complications of GERD are esophagitis, esophageal strictures and Barrett’s esophagus. Esophagitis is an inflammation of the esophagus and can range from inflamed mucosa to erosive ulcers occurring in a minority of GERD patients. GI bleeding may occur in ulcerated and eroded areas. Reflux-induced strictures are areas of thickened esophageal wall that narrow the lumen (the channel through which food must pass). Strictures occur in patients who have had relatively severe esophagitis. Barrett’s esophagus is a condition resulting from the abnormal healing of erosive esophagitis. The risk of developing Barrett’s is greater in patients with more severe and long-standing reflux symptoms. The significance of this condition is its tendency to develop into cancer of the esophagus. I have GERD.
What is a Nissen fundoplication?
This is a surgical procedure in which the upper part of the stomach is wrapped around the entire circumference of the lower esophagus. Any existing hiatal hernia is reduced. This procedure has been reported to produce relief of reflux in 80 to 85 percent of patients.
How is GERD treated?
GERD can be treated in several ways. The first approach is dietary and lifestyle modifications, e.g., decreasing the intake of foods that increase gastric acidity or reduce the pressure at the muscle at the lower end of the esophagus (caffeinated and decaffeinated foods, chocolate, peppermint and spearmint). Coffee, alcohol and acidic liquids affect esophageal peristalsis, and fatty foods slow gastric emptying and should be avoided. Large meals increase gastric pressure and therefore increase reflux. Smoking affects esophageal motor function, stimulates acid secretion and delays gastric emptying, potentiating reflux. Air swallowed while smoking increases the need for belching and therefore increases reflux. Lying down after eating should be avoided to keep the food in the stomach from refluxing into the esophagus. The head of the bed should be elevated at night to prevent the same type of reflux. Weight reduction is also recommended for those patients who are markedly overweight to lessen the frequency of reflux. New endoscopic techniques that are being developed may be useful to treat refractory reflux.
Drug therapy is used in combination with lifestyle changes. Acid-suppressing agents and drugs that enhance upper gastrointestinal motility are often prescribed. Surgery is the other choice to manage GERD. This mode of treatment is used primarily if the patient is unwilling or unable to cope with the lifestyle changes necessary for management of reflux disease. A Nissen fundoplication is the most common procedure performed.