My comments are in bold, the text from WebMD is in italics.
Barrett’s esophagus is a pre-cancerous condition that increases the
risk of esophageal cancer when compared to other patients with GERD. If you
have been diagnosed with Barrett’s esophagus, the cells in your esophagus have
changed, indicating that you have an increased risk of esophageal cancer, and
you should be in active “surveillance mode.” The management and treatment of
this condition is controversial. It is imperative that you have an
understanding of Barrett’s so that you can take control of your disease and
help select the management program that is best for you.
Could clarify here: potential
for healing (cells do not go away, but healing may occur around Barrett’s site;
repeat testing may find no Barrett’s since new sample will likely be taken from a at least slightly
different location in the esophagus).
In patients with Barrett’s, GERD symptoms
can be highly variable. The condition is a consequence of significant,
longstanding reflux and symptoms are usually severe. However, in some cases,
they may actually be quite minimal, particularly for those using acid
This statement does not correspond with my personal experience. I have Barrett’s. At the time of this diagnosis I had not been on
a PPI for over a month, had been on one
for three months earlier that year. My GERD symptoms began just 5 months prior to this
RefluxMD believes that patients with
Barrett’s esophagus require expert management. RefluxMD’s medical advisors have
identified a small group of GERD physicians who meet the highest standard and
follow the Pasadena
Protocol. We term these physicians Refluxologists. They are experts in the
management, diagnosis, and treatment of GERD, including Barrett’s esophagus and
its treatment strategies and options. You can begin your search for one of
these specialists using our Find a Physician directory.
One purpose of this site is clearly to solicit referrals for this
group of physicians.
I googled “Pasadena
Protocol” and got nothing but links to RefluxMD and some joke. I’m thinking if it were a protocol that this
physician group would like to see widely used by others, it would be mentioned
somewhere on the internet. Maybe it is a
protocol they plan promote through this site, and charge others for their
Barrett’s Esophagus: What Does It Mean To
With the diagnosis of Barrett’s esophagus, cancer risk becomes very important
along with symptom control. This represents a significant change in focus from
the other three stages of GERD. Esophageal cancer must be avoided.
This is perhaps the most offensive statement, designed to be very
frightening. This is where a responsible
source would explain that cancer of the esophagus progresses very slowly. Most people diagnosed with Barrett’s die of
other causes, not esophageal cancer.
Most have reached the end of the average life span.
Fortunately, Barrett’s should not be
feared, but it must be managed correctly. In actuality, the likelihood of
developing cancer is small. You have up to a .5% chance per year of developing
cancer, which translates to a 10% risk over 20 years.
This statistic was not computed accurately. You don’t add risk like that. Here is an explanation:
This statement inflates a person’s risk of esophageal cancer.
It is essential that those individuals
with Barrett’s esophagus undergo endoscopy every 1 to 3 years in order to
reevaluate the extent of disease. Biopsies are taken which will determine
whether your condition is “stable” or if it has progressed to a condition
called dysplasia, indicating an undesirable cellular change. Dysplasia carries
with it a higher risk of cancer when compared to Barrett’s.
Barrett’s Esophagus: Management Strategies And Treatment Options
As discussed earlier, the management of Barrett’s is controversial. There are
three treatment strategies available:
Medical management, primarily with PPIs;
Surgical procedures which restore the barrier to reflux, and;
“Ablative” procedures that “burn away” the Barrett’s tissue. Ablation is
combined with either surgery or PPI therapy.
The implementation of any of these therapies does not change the need for
periodic surveillance endoscopies as discussed previously.
This should specifically state that Barrett’s most often does not
progress. There is no need for surgical
treatment in most cases.
Acid suppressive PPIs control symptoms, but do not prevent or even reduce the
reflux. The chemicals (carcinogens) in stomach juice that are responsible for
the progression of Barrett’s to cancer continue to bathe the lining of the esophagus,
including the area of Barrett’s tissue. To date, RefluxMD has found no credible
evidence that acid suppressive drug therapy prevents the progression of
Barrett’s to dysplasia and ultimately esophageal cancer. In addition, PPI
therapy also has effects that, conceivably, might promote the development of
cancer in Barrett’s esophagus.
This is in fact a controversial statement. Dr. DeMeester was involved in a study
reported in mass media in 2011, that supported this statement. There was a study reported in 2009 with the
opposite results: PPI’s lower cancer
The NY times published the most recent overview I found: http://well.blogs.nytimes.com/2012/06/25/combating-acid-reflux-may-bring-host-of-ills/
They made no statement about PPI’s either increasing or decreasing
The surgical approach reconstructs the dysfunctional LES, improving its barrier
function to reflux. This actually stops the reflux which prevents the
carcinogen in the stomach contents from reaching the lining of the esophagus.
With a successful anti-reflux procedure, there is likelihood that cancer can be
prevented. Also, the symptoms caused by reflux are resolved, eliminating the
need for acid suppressive medications, including PPIs. As with any surgical
procedure there are risks and side effects that must be balanced with the
potential benefits. RefluxMD stresses that by understanding these aspects of
anti-reflux surgical procedures, an informed choice of therapy can be made.
Ablation means directly burning away the lining of the esophagus involved with
Barrett’s tissue. This is usually used for tissue that has progressed
beyond Barrett’s to dysplasia. After the affected area is treated, the
esophageal lining grows back to its original normal state in hopes of
decreasing or eliminating cancer risk. However, ablation does not stop the
reflux and GERD symptoms continue, requiring continued PPI therapy or an
anti-reflux surgical procedure.
Why the statement “Usually used?”
Under what circumstances would this procedure be used when there is no
dysplasia? Why would anyone undergo
unnecessary surgery with its inherent risks?
Understand Your Choices
Although seemingly complex, you should fully understand all of these options
and strategies for the management of Barrett’s esophagus. RefluxMD offers many
resources to answer your questions and assist you with your decisions. Take control
of your disease. The final choices and decisions must be made by you.
We can only make informed choices if given balanced information. This site simply does not do that. I would have no complaint if this site stated
it’s agenda up front, but it does not.
It specifically presents the information on this site as “the
truth”. I believe that the truth is
elusive, unfolds slowly over time with multiple studies. The “truth” represented by RefluxMD has not
been validated by other sources.