Gastric ulcer and Barrett's Esophagus?

I was diagnosed Monday with having a gastric ulcer and Barrett's Esophagus. I'm currently on 40 mg. per day of Zegerid (?) as treatment. (No h. pylori found during a biopsy). Anyone with experience of having Barrett's Esophagus? What are the chances of cancer? My gastroenterologist said not to worry--we'd talk about it at my two-week follow-up appointment, but I just did some research of my own, and now I'm terrified. Can anyone help calm my nerves/fears?

Hi,

Barrett's Esophagus is a condition whereby there is a change of the lining of the esophagus where it meets the stomach. This can been observed by the gastroenterologist when he/she scopes you, but can only be definitively diagnosed after pathologic examination of the cells (from biopsies that should have been taken). What is seen microscopically is a change in the normal type of cells in the esophagus to a type of cell seen more commonly in the stomach (sqamous cells become glandular/columnar cells).

Barrett's Esophagus is not cancer. It is not even pre-cancer (or carcinomat in-situ). It is a RISK FACTOR for developing esophageal cancer. Many sites that you read will overstate this risk. The risk of developing esophageal cancer for those with Barrett's Esophagus is estimated at 0.5% per year in any individual. (In the US, more recent studies have lead some to believe the risk is even lower than this, although it may be slightly higher in other countries.) The lifetime risk of developing esophageal cancer is very difficult to assess as I am not aware of any great long term data on this. Previously number around 20-25% lifetime risk were assumed, but now most suggest the risk is much lower than this. With routine surveillance, the hope is that in the few individuals who do develop cancer it will be found early and easily treated.

Despite all this scary talk of esophageal cancer, there are also some papers out there that note the mortality rates and life expectancies of individuals with Barrett's are no different than that of the general population.

As to what you should do, it sounds like you are on the right track. You are taking an acid suppressor and are being followed by a GI doc. As you are aware that you are at somewhat increased risk for esophageal cancer, you now know that it is more important to seek medical attention promptly if you have sypmtoms like: difficulty swallowing, unintended weight loss, vomitting blood.

I would emphasize that perhaps the most important part of this for you would be dealing with this mentally/emotionally. Given the low risk, it is very possible that the psychologic ramifications of the diagnosis will hurt your qualityof life more than any cancer ever will. While Barrett's is not at all to be taken lightly, you are doing everything you can, the vast majority of people in your situation never get cancer, and overall your life expectancy is no different from anyone else of your age group.

I hope that helped a little. Good luck.


Here are some fairly lay web-sites to read:
http://www.aafp.org/afp/20040501/2113.ht...
http://www.mayoclinic.com/health/barrett...

I don't have experience with this but it sounds like your doctor isn't too worried about it. Don't worry about it too much.

good luck.

Ask whether or not the biopsy that demonstrated Barrett's showed any evidence of dysplasia (abnormal cell growth). If there is dysplasia, ask what grade of dysplasia. High grade dysplasia from Barrett's has approximately 1% chance of developing adenocarcinoma of the esophagus or stomach. Because of the location adenocarcinoma in this area is almost always eventually fatal and this is why it is important to stop the gastric reflux, allow the damage to heal and then watch the area for any changes that might indicate potential to develop cancer. Not all Barrett's develops dysplasia and only a small percent of this dysplasia turns into cancer but gastric reflux and Barrett's are common problems so you don't want to neglect this issue and take the chance of developing adenocarcinoma. You'll need an endoscopy every one to three years from now on to monitor the condition.

http://digestive.niddk.nih.gov/ddiseases...