Low-Grade Esophageal Variations: Diagnosis and Treatment Options

Low-grade esophageal dysplasia?

Hello Doctor: Below is the endoscopy report from last month.
The physician advised that my esophagus needs to be addressed promptly (endoscopic RFA).
I have been trying to adjust my lifestyle for the past two years, but I have not been able to achieve effective improvement.
The results of my three endoscopies this year have been inconsistent.

ESOPHAGUS: Upward tongue-like mucosa with mucosal breaks measuring 5mm, C2M3.

STOMACH: Hiatal hernia.
Some clean-based ulcers.

Diagnosis: Rule out Barrett's esophagus, C2M3, reflux esophagitis, LA Grade B, gastric ulcers, hiatal hernia, Hill's grade II.

Guo Shuijin, 70~79 year old female. Ask Date: 2024/07/01

Dr. Lin Minghui reply Gastroenterology and Hepatology

If the endoscopic biopsy shows Barrett's esophagus with dysplastic lesions, consideration may be given to applying endoscopic radiofrequency ablation (RFA) to treat the lesions.
This is to prevent low-grade dysplasia from progressing to high-grade dysplasia and to prevent high-grade dysplasia from progressing to cancer.
Please discuss this with the attending physician.
Best wishes for your health!

Reply Date: 2024/07/01

More Info

Understanding low-grade esophageal variations, particularly in the context of your recent endoscopy findings, is crucial for effective diagnosis and treatment. Your report indicates several significant findings, including mucosal breaks in the esophagus, potential Barrett's esophagus, reflux esophagitis, and gastric ulcers, alongside a hiatal hernia.

Diagnosis Overview
1. Mucosal Breaks: The presence of mucosal breaks, especially those less than 5mm, suggests inflammation or damage to the esophageal lining, often associated with gastroesophageal reflux disease (GERD). This can lead to symptoms such as heartburn, regurgitation, and difficulty swallowing.

2. Barrett's Esophagus: The mention of "r/o Barrett's esophagus" indicates that your physician is considering the possibility of this condition, which is characterized by changes in the cells lining the esophagus due to chronic acid exposure. Barrett's esophagus is a precancerous condition that can increase the risk of esophageal adenocarcinoma.

3. Reflux Esophagitis: This condition is an inflammation of the esophagus caused by the backward flow of stomach acid. The classification of LA Grade B suggests moderate damage to the esophageal lining.

4. Gastric Ulcers and Hiatal Hernia: The presence of gastric ulcers and a hiatal hernia can complicate the management of GERD and Barrett's esophagus, as they can contribute to increased acid exposure and symptoms.

Treatment Options
Given your diagnosis, treatment options may include:
1. Lifestyle Modifications: Since you've already made efforts in adjusting your lifestyle, it’s essential to continue focusing on dietary changes, weight management, and avoiding triggers such as spicy foods, caffeine, and alcohol. Elevating the head of your bed and avoiding meals close to bedtime can also help reduce reflux symptoms.

2. Medications: Proton pump inhibitors (PPIs) are commonly prescribed to reduce stomach acid production and promote healing of the esophagus and stomach lining. It’s important to discuss the duration of PPI therapy with your physician, especially considering your concerns about calcium absorption due to osteoporosis.

3. Endoscopic Treatments: If Barrett's esophagus with dysplasia (abnormal cell changes) is confirmed, endoscopic radiofrequency ablation (RFA) may be recommended. This procedure aims to destroy the abnormal cells and reduce the risk of progression to esophageal cancer.

4. Regular Monitoring: Given the potential for Barrett's esophagus, regular endoscopic surveillance is crucial. Your physician may recommend follow-up endoscopies every 6 to 12 months, depending on the severity of your condition and any changes observed.

5. Surgical Options: In cases where medical management fails, surgical interventions such as fundoplication (a procedure to reinforce the lower esophageal sphincter) may be considered, especially if a hiatal hernia is contributing to your symptoms.

Conclusion
In summary, your diagnosis of low-grade esophageal variations, particularly in the context of Barrett's esophagus and reflux esophagitis, requires a comprehensive approach to management. It is essential to maintain open communication with your healthcare provider regarding your symptoms, treatment efficacy, and any concerns you may have about medications or procedures. Regular monitoring and proactive management can significantly improve your quality of life and reduce the risk of complications. Always consult your physician before making any changes to your treatment plan or lifestyle.

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