Disorders of the Gastrointestinal System, 2nd Edition
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EVIDENCE-BASED PRACTICE ALERT Previously, it was thought that the bacteria Helicobacter pylori may in- crease the risk of developing Barrett’s esophagus when present in the stom- ach. However, recent research has shown the opposite may be true— H. pylori may have a protective effect on the mucosa. Although this finding is unclear, some researchers have posit- ed that the bacteria can prevent the stomach contents from damaging the esophageal mucosal tissue (Medical University of South Carolina [MUSC], 2022). Esophagitis Esophagitis is the term used to describe an inflammation of the esophagus lining, which can cause pain, bleeding, and dys- phagia. Esophagitis can be caused by a variety of factors (Devuni & Birk, 2020). GERD ● Certain medications, including NSAIDs, aspirin, osteoporosis medications, and iron supplements. candidiasis, herpes simplex virus (HSV), and cytomegalovirus (CMV). ● Certain allergies or inflammatory reactions, such as asthma (Antunes & Sharma, 2022). Diagnosis typically involves an esoph- ageal barium study or esophagography, especially in patients with dysphasia. An upper endoscopy can also assess the ex- tent of tissue damage and identify erosion areas. Most cases of esophagitis resolve within a few days of identification once treatment is started, but this depends on the underlying cause and whether that ● Cancer treatments such as chemotherapy and radiation. ● Certain infections, including
Barrett’s esophagus is diagnosed via an upper endoscopy and biopsy. After inser- tion of the endoscopic tube, the health- care provider can inspect the lining of the esophagus and note the presence of an abnormal lining. However, a biopsy of the lining of the esophagus is necessary to confirm the presence of a malignancy (Spechler, 2022b). Several treatment options for Barrett’s esophagus with severe dysplasia or ma- lignancy are available. The focus of these options is to destroy or remove the sec- tion of the lining that is dysplastic or can- cerous. Several endoscopic therapies may be used to treat Barrett’s esophagus under these conditions (Spechler, 2022b): ● Radiofrequency ablation (RFA) : This treatment uses radio waves to kill precancerous and cancerous cells by heating an electrode on an endoscope. ● Endoscopic cryotherapy : This approach uses liquid nitrogen or another cryogen to freeze the area of concern, disrupting the ability of the mutated cells to reproduce by damaging them and the vessels that supply them with blood. ● Endoscopic mucosal resection (EMR) : During an EMR, the affected mucosal lining is incised and removed through an endoscope. Complications can include bleeding or tearing of the esophagus. EMR may be performed in conjunction with PDT. Esophagectomy (surgical removal) may be recommended in severe dysplasia or malignancy cases.
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