CONDITIONS OF SPECIAL INTEREST
The oesophagus passes food from the mouth to the stomach. When food is swallowed, the oesophagus moves the food down to the stomach, passing a valve (known as the sphincter) into the stomach. When this valve is weak, the stomach acids can push up through this valve and enter the lower oesophagus, this is called reflux. While many people struggle with heartburn due to reflux, when reflux is left untreated it can develop into Barrett's oesophagus in which the cells in the lining of the lower oesophagus change. These changes in cells may eventually turn cancerous.
What are the related symptoms?
Barrett's oesophagus or Barrett's Syndrome will involve symptoms of persistent gastro-oesophageal reflux disease (GORD) such as:
- Persistent heartburn
- An unpleasant, sour taste in the mouth caused by regurgitation
- Difficulty swallowing
- Painful swallowing
- Chest pain
- Nausea & vomiting
- Feeling like you are full during eating
- Unexplained weight loss
Because this condition leads to changes in the cells, these cellular changes can be at risk of turning cancerous. While those with Barrett's oesophagus are at higher risk of developing cancer, if diagnosed early Dr Mokhele may help prevent further cell changes.
What causes Barrett's Syndrome?
The main cause of Barrett's oesophagus is gastro-oesophageal reflux. While not everyone with reflux will develop this condition, it is usually those who have had severe reflux for many years. It is believed that the exposure to stomach acid and bile during times of reflux may be the cause of cell change in the oesophagus. Barrett's oesophagus is also more common in those who are overweight, smoke, drink alcohol often, eat spicy, acidic or fatty foods or have a hiatus hernia as these cause more exposure to the stomach acid.
What does management or treatment involve?
While many people live with persistent gastro-oesophageal reflux disease (GORD) and its symptoms, Dr Mokhele may help manage this condition to enhance their quality of life and prevent secondary conditions like Barrett's Oesophagus. As a specialist Gastroenterologist, he may use the following diagnostic tests to examine the state of the oesophagus:
- Gastroscopy - to get a better view of the internal condition of the oesophagus.
- Endoscopic biopsy – this may be done to test for cell changes in the tissue.
- Twenty-four-hour ambulatory pH monitoring – this may be done to see how much the lower oesophagus is exposed to stomach acid.
If diagnosed, Dr Mokhele will provide you with the necessary support and help find the most suitable treatment for you. Treatment may be focused on eliminating acid reflux with medications or by making some lifestyle changes such as losing weight and stopping smoking. In some cases, endoscopic microsurgery may be needed to remove small tumours from the lower oesophagus. Other endoscopic techniques such as an argon plasma coagulation, photodynamic therapy (PDT), multipolar electrocoagulation and cryotherapy which your gastroenterologist may explain in more detail if he deems one of these treatments suitable for you.
In severe cases where lifestyle changes, microsurgery or other treatments don't seem to work, surgery may be needed to repair the hernia (if present) or strengthening the weak valve (with a surgery known as Fundoplication). In some cases where the diagnosis was made rather late, extensive surgery is needed to remove the lower part of the oesophagus with abnormal cells. In such cases, Dr Mokhele may refer you to a specialist surgeon.
Gastrocure, Eastern Cape
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