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PD Dr.med.Eckhard Löhde

What exactly is this "Barrett"?

Dear readers,

As a patient with reflux problems, you will certainly have heard the term "Barrett's esophagus". This topic has been controversially discussed in science for decades. Knowledge about Barrett's has also changed considerably over time, but the range of studies is still wide. Let me give you the core of what we know today:

Barrett's esophagus was first described by the British surgeon Norman Rupert Barrett in the 1950s and introduced into medical nomenclature. Barrett's is the abbreviated name for cell changes in the lower esophagus caused by reflux. The delicate and helpless mucous membranes in the esophagus are so tormented by the rising stomach acids that they look for ways to defend themselves. The biological idea is to transform into gastric mucosa, because gastric mucosa has such enormous resistance to acids and digestive enzymes. The plan is not bad in principle and as a result cells are actually formed that resemble gastric mucosa cells. But real stomach cells cannot form, of course, and so everything ends up in these malformed Barrett cells - unfortunately with the risk of further malformation and even cancer.

In the 1990s, it was assumed that the risk of developing esophageal cancer in people with Barrett's esophagus was more than 100 times(!) higher. However, these study results have not been confirmed over time, and the risk is much lower. In particular, different stages of cell changes can now be distinguished. The most common stage by far is so-called metaplasia, the very first Barrett's stage. The increase in gastroscopy and the use of new medications have helped to curb the development of more severe cell changes.

Today, the risk of cancer from Barrett's metaplasia is considered to be lower and there is no reason to be overly afraid of suddenly developing esophageal cancer. The findings should be checked endoscopically every three to four years with a sample taken. If the Barrett's cells do show advanced stages of degeneration, that is not a good sign! The damage process has not been stopped by the treatment. This is bad and the mucous membranes must be peeled off and destroyed with heat using an endoscope. It is therefore important to be careful and to look after the esophagus in terms of diet. Many patients often feel an inner restlessness and the feeling that they are carrying a kind of time bomb inside them.


It is important for you to know: The appearance of Barrett's cells is not a coincidence but always(!) a desperate cry for help from the esophagus! It is always a sign of gastroesophageal reflux and must be treated early and correctly. As always, the best thing is to stop the development of Barrett's in time with the right therapy. The following was written to me by a patient who, despite the terrible symptoms, took far too long to finally get the right diagnosis and start therapy:


"Waking up at night because of breathing difficulties when lying down, barely able to sleep, dry throat, swallowing problems, lump in throat, high pulse with breathing difficulties. Got to GP because of sore throat, burning in mouth, tongue and palate, then ENT. Irritation otherwise OK. Then to lung specialist: tumor search! Ultrasound, histamine test, allergy, ECG, laboratory, MRI skull. Gastroscopy: everything is OK, only slight esophagitis. PH measurement: 2.0 better than normal. Finally the diagnosis: "hypersensitive esophagus". But what now? Have to live with it. Further deterioration over time. Only still water, strict diet, more sleep. Some nights in an armchair. Burning, lump in throat, swallowing getting worse. I hardly dare to eat anymore. Weight is decreasing all the time. Relationship with my girlfriend is being put to the test. Again and again to ENT, no tumor! How nice, but how do I get healthy? GP suspects "burn out" because I am actually very exhausted. Dark circles under my eyes, coated tongue. I refuse to take tablets. At some point I had another gastroscopy, this time somewhere else. This time a small hiatus hernia was seen and a sample was taken from my esophagus. Result: Barrett's esophagus! That was a blow. Now I'm taking PPI 2x40mg. I'm better off with that..."


Yes, it is tricky when gastroscopy and pH measurement are trusted more than the patient's symptoms. All examinations without exception(!) always have an error rate and can overlook the actual findings. In this case, the damage process in the esophagus continued unabated until the cells had no other option than the Barrett's change.


Yours

Barrett's esophagus, esophagus, inflammation, stomach, gastritis, Helicobacter, heartburn, acid reflux, breastbone pain, Florian Thomas, Eckhard Loehde, Löhde, reflux, stomach, Barrett, cancer, cough, earache, sensitive teeth


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