At Johns Hopkins, our experienced doctors use their expertise along with the most advanced imaging technologies to make a careful and accurate diagnosis. We are one of the few centers in the country using endoscopic confocal microscopy endomicroscopy , in which a powerful microscope is used to help diagnose a condition during an endoscopy.
In vivo real-time examination of the cells during endoscopy can be performed by a small microscopic probe or an endomicroscope mounted on a detailed, high-resolution image that is used to identify abnormalities, allowing physicians to detect cancer cells without a biopsy. A diagnosis of Barrett's esophagus begins with a comprehensive physical exam during which you describe your symptoms and medical history. Other diagnostic procedures include:.
A gastroenterologist will most likely perform an upper endoscopy with biopsy to help diagnose Barrett's esophagus. During this procedure, the lining of the esophagus is checked for abnormalities.
The endomicroscope is often used to analyze the tissue during an endoscopy, avoiding the need for a more invasive biopsy. An upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and the first part of your small intestine, called the duodenum. A gastrointestinal endoscopy examines the mucous lining of your upper gastrointestinal tract. The endoscopy and biopsy are two parts of the same procedure:.
A chromoendoscopy also may be used during an upper endoscopy procedure. A chromoendoscopy is a procedure that uses staining to identify abnormal areas that may be malignant cancerous. During the endoscopy, we apply stains to the esophagus with a liquid called Lugol's solution. The dye stains only the normal cells; unstained areas may be malignant.
The unstained areas are easily seen and tissue is removed from that area and sent for biopsy. In this procedure, your doctor will insert the LINX device around lower esophagus. The LINX device is made up of tiny metal beads that use magnetic attraction to keep the contents of your stomach from leaking into your esophagus. A doctor performs the Stretta procedure with an endoscope.
Radio waves are used to cause changes in the muscles of the esophagus near where it joins the stomach. The technique strengthens the muscles and decreases reflux of the stomach contents. Your doctor may recommend more invasive procedures if you have high-grade dysplasia.
For example, removing damaged areas of the esophagus through the use of endoscopy. In some cases, entire portions of the esophagus are removed. Other treatments include:. This procedure uses an endoscope with a special attachment that emits heat. The heat kills abnormal cells. In this procedure, an endoscope dispenses cold gas or liquid that freeze the abnormal cells. The cells are allowed to thaw, and then are frozen again.
This process is repeated until the cells die. Your doctor will inject you with a light-sensitive chemical called porfimer Photofrin. An endoscopy will be scheduled 24 to 72 hours after the injection. During the endoscopy, a laser will activate the chemical and kill the abnormal cells.
Possible complications for all of these procedures may include chest pain, narrowing of the esophagus, cuts in your esophagus, or rupture of your esophagus. However, many people with this condition never develop cancer.
If you have GERD, talk with your doctor to find a treatment plan that will help you manage your symptoms. Your plan may include making lifestyle changes such as quitting smoking, limiting alcohol consumption, and avoiding spicy foods. You may also start eating smaller meals low in saturated fats, waiting at least 4 hours after eating to lie down, and elevating the head of your bed.
All of these measures will decrease gastroesophageal reflux. You also may be prescribed H2-receptor antagonists or proton pump inhibitors. Significantly, most people with GERD have no such abnormality. Figure 1 illustrates the anatomy of the esophagus. Normally, the esophageal lining the epithelium consists of flat, layered cells similar to those in the skin. This squamous epithelium stops abruptly at the junction of the esophagus with the stomach near the lower end of the lower esophageal sphincter.
The epithelium of the rest of the gut, down to the anus, consists of a single layer of side-by-side rectangular cells, which is called columnar epithelium. In some people, the transition from squamous to columnar epithelium occurs higher within the esophagus than normal. There may also be islands of columnar epithelium above the normal junction of the stomach and esophagus. The figure illustrates a normal esophagus, the organ that connects the mouth to the stomach.
The lining epithelium of the esophagus down to the lower esophageal sphincter is normally squamous. One esophagus may contain several types. The process of cell change from flat, layered squamous to tall columnar epithelium is an example of metaplasia. Columnar cells are more resistant to acid and pepsin and the metaplasia may be a defense against refluxed acid. They include mucus cells, and have a tendency to resemble cells found in the small intestine.
Squamous epithelium, seen in the esophagus and skin, consists of layers of flat cells. Columnar epithelium, characteristic of the rest of the gut, consists of a single layer of tall, rectangular cells. Normally, the point where the red tissue that lines the stomach gastric mucosa ends and the paler pink squamous esophageal mucosa begins sharply demarcates the junction between the stomach and the esophagus.
It may reach upwards in tongue-like projections of gastric tissue into the esophagus, as islands of gastric mucosa amongst the esophageal squamous, or may involve the whole circumference of the esophagus to a certain level.
This abnormal columnar tissue may extend to any level within the esophagus, even as high as the upper esophageal sphincter. The doctor, through endoscopy, can normally recognize the abnormal metaplastic tissue, but an overlying inflammation due to reflux may obscure it. However, a study in the general population suggested a rate of 0. The risk is real and is further increased by factors such as tobacco and alcohol use. Also, the risk is greatest if the metaplastic epithelium is of the specialized columnar type and if the area of metaplasia is large.
Called dysplasia, these changes are an indication for repeated endoscopy and biopsy. Dysplasia is an abnormal condition in which cells may have altered shape or may divide in a manner that alters the appearance of the tissue or organ. The degree of change ranges from minor to significant changes low-grade , to serious or very abnormal changes high-grade dysplasia.
Failure of dysplasia to regress with treatment should prompt close surveillance repeated endoscopy. One of the esophageal cancers is squamous cell carcinoma that develops often also with the help of tobacco and alcohol in the normal squamous cell lining of the esophagus.
This cancer may be treated by radiotherapy or surgery. The incidence of this cancer is increasing in North America especially in white males, and adenocarcinomas do not respond well to radiation treatment.
Esophagitis is commonly treated with medications to control acid production or secretion primarily proton pump inhibitors.
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