Digestive Trac • November 2015

NON-PROFIT U.S. POSTAGE PAID SIOUX FALLS, SD PERMIT NO. 7010

Avera McKennan 1325 S. Cliff Ave. Sioux Falls, SD 57105

Hours: 8 a.m. - 5 p.m.

605-322-7797 To learn more, visit our website at AveraDigestiveDisease.org

Get your FREE mobile Digestive Trac at Avera.org/TRAC-register!

15-GAST-5686

GI Malignancy RFA Technology Reflux Disease and Barrett’s Esophagus

INSIDE THIS ISSUE: DIGESTIVE DISEASES • NOVEMBER 2015

DigestiveTrac

RFA TECHNOLOGY A Minimally-Invasive Cure for Barrett’s Esophagus

“

If a patient has metaplasia, we see a 98 percent success rate. Even with high dysplasia, the patient has a 90 percent success rate of developing normal esophageal tissue again.

“

- Brad Thaemert, MD, board-certified Surgeon

GI MALIGNANCY Early Diagnosis Offers the Best Survival

“

Often with esophageal cancer, we find it in its more advanced stages, and so we offer a course of chemotherapy and radiation preoperatively to shrink the tumor and make surgery more successful.

“

- Heidi McKean, MD, board-certified Medical Oncologist

A novel treatment option known as radiofrequency ablation (RFA) can cure Barrett’s esophagus in the vast majority of patients, and virtually eliminate the higher risk of esophageal cancer.

During an outpatient endoscopic procedure, radiofrequency ablation (RFA) therapy is used to thermally injure the superficial layer of the esophagus – about 1 mm of tissue. In the healing process, the affected layer sloughs away, and new, healthy esophageal lining tissue grows in its place. This procedure has a 90 to 98 percent five-year success rate of curing Barrett’s, depending upon how advanced the disease is.

The Avera Digestive Disease Institute uses the HALO System

by Barrx Medical.

While the patient is sedated, a catheter is inserted through the mouth into the esophagus and used to deliver a controlled level of energy and power to remove a thin layer of diseased tissue. Larger areas of Barrett’s tissue are treated with the balloon-mounted catheter. Smaller areas are treated with the endoscope-mounted catheter. Both are introduced during an upper endoscopy procedure.

RFA can be used through all three levels of dysplasia – metaplasia (non-dysplastic), low-grade dysplasia and high-grade dysplasia.

Malignancies of the esophagus, gastroesophageal junction (GEJ) and stomach are rare in the United States, yet deadly.

Early detection gives patients the best chance of survival.

In times past, most cases of esophageal cancer were squamous cell cancers linked to smoking and heavy drinking. Today, squamous cell cancers make up less than half of esophageal cancer; the majority are now adenocarcinomas which occur due to cell changes in the esophagus, stemming from Barrett’s esophagus.

Adenocarcinoma of the esophagus rates have risen dramatically from 3.6 per million in 1973 to 25.6 per million in 2006 (PubMed. gov). This makes it the fastest-growing cancer in the U.S., according to the National Cancer Institute.

Postoperative chemotherapy and radiation is often recommended to prevent recurrence. A recent development in upper GI cancers is testing patients for the HER2 marker, commonly associated with breast cancer. “Thirty to 40 percent of patients do test positive for HER2, meaning that we can take specific aim at the tumor by adding Herceptin® to chemotherapy – a nice direction toward improving overall survival,” Dr. McKean said.

Contact Avera DDI through our Navigator: Liz Harden, CNP 605-322-7334 elizabeth.harden@avera.org

SIGNS AND SYMPTOMS When to Seek Specialty Referral Classic symptoms of gastroesophageal reflux disease:

Symptoms that warrant diagnostic testing or referral

• Difficulty swallowing

• Medications are ineffective in controlling symptoms

• Frequent heartburn and indigestion

• Dysphasia (difficulty swallowing)

• Non-cardiac chest pain

• Unexplained weight loss

• Blood in the stool

Less common signs of laryngopharyngeal reflux (LPR)

• Anemia

• Chronic cough

• Frequent throat-clearing

• Feeling of a lump in the throat

• Excessive mucus in the throat when eating

Gastroenterology

Avera Digestive Disease Multidisciplinary Team The Avera Digestive Disease Institute brings together a multidisciplinary team to address cancer and other conditions of the digestive tract, all working toward the goal of seamless care and the best possible outcomes.

Avera gastroenterologists ensure that each

Navigator

patient affected by digestive disease is treated with the fullest extent of expertise and the latest medical technology, for example, advanced endoscopy and radiofrequency ablation.

The DDI navigator serves as an access point for all questions, concerns and issues and follows all patients with a digestive system cancer.

Surgeons Avera Digestive Disease Institute surgeons offer minimally invasive procedures in the case of operable upper GI cancers, resulting in a smaller incision, less potential for pain and faster recovery.

RADIATION AND MEDICAL ONCOLOGY

Be A Survivor Learn more about successfully dealing with a colorectal cancer diagnosis.

BeASurvivorAveraColon.com

Avera radiation and medical oncologists are experienced in treating GI cancers, either pre- or postoperatively, or as a curative or palliative approach in the case of inoperable tumors.

REFLUX DISEASE AND BARRETT’S ESOPHAGUS

Importance of Early Management and Surveillance

Fortunately, this disease has numerous effective treatment options, so that most patients do not suffer serious long-term complications. Yet left untreated, GERD can result in ulcerations, narrowing and strictures of the esophagus, as well as Barrett’s esophagus, in which cells of the esophagus change to resemble cells of the stomach and intestine. This condition can in turn lead to esophageal adenocarcinoma, which is growing in numbers.

GERD is treated first with the most conservative approaches including diet and lifestyle change. The next course of action is medication – H2 blockers and proton pump inhibitors (PPIs), which can be used safely in the long term.

Barrett’s is estimated to affect between 2 and 7 million adults over 40 years of age. While Barrett’s is not a painful or life-threatening condition in itself, patients with Barrett’s esophagus have a risk of developing cancer of the esophagus that is 30 to 125 times higher than patients without this condition. In Barrett’s esophagus,

605-322-7797

To learn more, visit our website at AveraDigestiveDisease.org

the cells that line the inside of the lower esophagus are replaced by columnar cells resembling those that line the inside of the stomach or intestine.

“I believe worsening acid reflux is a result of increasing body mass index – or obesity – in our society,” said Steven Condron, MD, board-certified Gastroenterologist. The typical sufferer of Barrett’s is a white male who is overweight, although it can affect all ages, both genders, and people of all body types.

It is estimated that 13 percent of the people who have chronic acid reflux also have Barrett’s esophagus. Yet Barrett’s is asymptomatic, so any patient who has had acid reflux disease for five years or more should consider endoscopy to rule out this condition.

“

Because adenocarcinoma of the esophagus is a very serious form of cancer, often with a poor prognosis, prevention is our ultimate goal in the proper diagnosis, treatment and surveillance of Barrett’s esophagus.

“

Disease of the upper gastrointestinal tract is gaining increased attention from physicians and patients alike, as more and more people report symptoms of gastroesophageal reflux disease (GERD). In fact, 60 percent of the adult population will experience some type of GERD within a 12-month period and 20 to 30 percent will have weekly symptoms. (Healthline)

- Steven Condron, MD, board-certified Gastroenterologist