Disorders of the Gastrointestinal System, 2nd Edition
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EVIDENCE-BASED PRACTICE Chronic gastroesophageal reflux dis - ease can lead to Barrett’s esophagus, where normal squamous cells of the esophagus are replaced with colum- nar cells. Research is being done at this time to identify which specific cells migrate to the site of the dam- age. Previously, it was thought that cells developed into the wrong type (instead of squamous cells, they would develop into columnar cells), but recent research has noted that the changes may result from stem cells coming from the gastric mucosa and developing into columnar cells. Bar- rett’s esophagus is highly associated with adenocarcinoma of the esopha- gus (Spechler, 2022a). Squamous cell carcinoma Squamous cell carcinoma occurs in the squamous cells that are located in the lining of the esophagus. The major risk factors for developing esophageal squa- mous cell carcinoma are cigarette smok- ing and chronic heavy alcohol consump- tion (ACS, 2022a).
CASE STUDY 2: PART 1 Lee is a 55-year-old man who arrived in the U.S. from Taiwan about 20 years ago. He is a heavy cigarette smoker, having smoked two packs per day for over 30 years. His wife tells him that his voice is different and hoarse. Lee also comments that he is having difficulty swallowing. These symptoms began several months ago and have become gradually, but steadily, worse. Lee decides to visit his doctor, who suspects an esophageal dis- order. A biopsy of esophageal tissue con- firms a malignancy. Question Lee has reported swallowing difficulty. Which recommendations would you consider discussing with Lee to address this issue? a. Eat larger meals less frequently throughout the day to prevent b. Gargle with salt water to help with the hoarseness and voice changes. c. Eat smaller meals more frequently to decrease the risk of aspiration. multiple pain episodes and decrease the risk of choking. d. Increase his intake of pickled vegetables to add fiber to his diet. Answer/Rationale: The correct answer is c. Those who report swallowing difficulties should eat smaller meals and take smaller bites to decrease the risk of aspiration.
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