0:04 Barrett's esophagus, I usually describe as cells in the esophagus after chronic acid
0:10 reflux, start to change and turn into pre-cancerous cells.
0:15 The population that's most affected by Barrett's esophagus are white, Caucasian males, over
0:22 the age of fifty.
0:23 The hard part about screening for Barrett's esophagus is that most patients of Barrett's
0:28 esophagus have no symptoms. The only small sign that we get are patients who have had
0:35 heartburn for a long time. In general, we do recommend patients who have had heartburn
0:41 for five to ten years, definitely discuss it with their primary care physicians.
0:46 Unfortunately, some patients have heartburn and, actually don't feel it. A lot of times,
0:51 by the time symptoms develop, such as difficulty swallowing, or food getting stuck that's usually
0:58 a little late. At that time, usually a tumor has developed.
1:02 So, when Barrett's esophagus is suspected, the first thing we do is review the biopsy
1:07 results as well as the endoscopy results, to confirm that Barrett's esophagus is present.
1:14 Not infrequently, someone could be thought to have Barrett's esophagus, but actually,
1:19 they just have inflammation of the esophagus.
1:22 Once Barrett's esophagus is confirmed, we look for something called dysplasia. Dysplasia
1:28 means pre-cancerous changes. When dysplasia is found, we can actually, get rid of that
1:35 by a minimally invasive method, called radiofrequency ablation and more recently cryoablation. It's
1:43 just fancy words saying, using heat or using liquid nitrogen to freeze those bad tissues
1:50 and allow the esophagus new healthy cells to form.
1:54 Once Barrett's esophagus with dysplasia is eradicated, we perform a test to decide whether
2:02 or not medication, is sufficient to control acid reflux. If not, then the patients will
2:08 be referred for consideration of something called fundoplication, or surgery, which is
2:13 to tighten the valve between the esophagus and the stomach and prevent acid reflux from
2:18 occurring and thus, hopefully, prevent Barrett's esophagus from reoccurring again.
2:24 The best method for preventing Barrett's esophagus is a healthy diet, high fruits and vegetables,
2:31 avoiding tobacco smoking, avoiding drinking, and, also treating heartburn.
2:36 There are a lot of exciting things going on here at Stanford. In addition to radio frequency
2:42 and cryoablation, we also have advanced imaging technique called confocal microscopy which
2:49 allows us to look at the esophagus as if we're looking with a microscope to help us better
2:55 pinpoint the location of the Barrett's esophagus.
2:59 My immediate hopes for this field is better education and awareness, especially to the
3:04 patients not to ignore heartburn, that it really is a warning sign.
3:09 Long term goal, I hope to decrease the incidence¬ of esophageal cancer. More recent data has
3:14 shown that the incidence of esophageal cancer has tripled in the last twenty years, while
3:21 a lot of the other cancers have either decreased in incidence, or plateaued. We think obesity
3:26 has to do with it. We think our diet has to do with it. And I hope to be part of the team
3:33 that helps bring that incidence down.