We then do two endoscopies, approximately a year apart. After that, if there is no dysplasia or abnormality beyond the Barrett's, then the patient at this point would have endoscopy every two or three years. Now, if you have dysplasia or abnormal cells, I think it's sufficient to say that you should be surveyed more frequently to be ahead of the game, so to speak, if the dysplasia is going to progress.
Are there any additional treatments if dysplasia is found?
At that point, it is important for the physician to have another discussion with the patient about investigational therapies. And I say "investigational" because we have the capability of removing this tissue using either thermal therapy, laser therapy and now we even have the capability to endoscopically remove tissue.
The problem is that it is hard to prove that you can remove all the tissue. Since even a little bit could be bad, we've kind of hesitated to make a blanket recommendation that if you have dysplasia you should attempt to have it removed. But it's an important discussion to have with patients because, as you can guess, people don't like to sit there with it.
Does someone with minor reflux need to be worried about getting Barrett's?
One of the overall problems with reflux is that people don't stop refluxing simply because they're on a drug like Nexium or Prevacid. Even with these drugs, they're still refluxing material that is not as damaging, so they aren't getting symptoms. And even with surgery you don't completely eliminate reflux.
I think anyone who has a long-term need to take medication for heartburn or who is given a diagnosis of reflux would do well to consult a care provider to understand what their risks are.
Certainly, if you are in the typical Barrett's age group—over the age of 50—and you have an endoscopy that does not show any Barrett's, I would be very comfortable telling you that you didn't need another screening.
What advice do you have for someone with reflux disease?
Anyone with reflux disease should learn about Barrett's so that they can be informed as to their potential risk. This is an evolving field, and we're learning enough about the disease that going forward, our technologies are going to evolve to a point where if we can make an impact in treating Barrett's esophagus, it's going to be early on in the disease.