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Rapid Healing of Severe Exudative Barrett's Esophagitis May Promote Cancer Development

MOHAMMAD FARIVAR, NORWOOD HOSPITAL, ONE LENOX STREET, NORWOOD, MA 02062

In three patients with severe exudative distal esophagitis, healing was marked by endoscopically visible Barrett's mucosa and invasive adenocarcinoma within one year of continuous omeprazole treatment.

Case 1: 35 year old white male with chief complaint of dysphagia was found to have hiatus hernia (HH) and severe exudative distal esophagitis in 12/92. Biopsies revealed Barrett's mucosa, acute inflammation and necrotic exudate. Treatment with ranitidine and cisapride was instituted. On 7/94 EGD showed no significant change. Biopsy showed the same plus marked reactive atypia. Omeprazole 40 mg. daily was prescribed. On 8/95 EGD revealed "now” grossly evident Barrett's mucosa with a one cm. nodule within it. Biopsies showed well differentiated adenocarcinomas on a background of high grade dysplasia. Curative esophago-gastrectomy was performed on 9/95 and there was no evidence of invasion.

Case 2: 44 year old white male underwent EGD on 11/94 for evaluation of epigastric pain and heartburn; it revealed HH, exudative distal esophagitis and duodenal ulcer. Biopsy showed acute exudative inflammation, intestinal metaplasia, and severe cytological atypia which became mild after 3 months of treatment with omeprazole 40 mg. daily for three months followed by 20mg. daily for relief of heartburn. On 4/96 EGD revealed nodularity involving most of the "now" grossly evident Barrett's mucosa. Biopsies showed poorly differentiated adenocarcinomas. Curative esophago-gastrectomy was done. There was submucosal invasion.

Case 3: 55 year old white male with dysphagia was found to have HH, exudative Barrett's esophagitis and stricture on 10/93. Biopsy and brushing showed Barrett's with mild to moderate dysplasia. Omeprazole 40 mg. daily for three months followed by 20 mg. daily was prescribed for relief of heartburn. On 5/95 EGD showed Barrett's mucosa with severe granularity. Biopsy revealed moderately well-differentiated adenocarcinoma. Curative resection on 6/95 showed invasion into the muscularis.

Conclusion: It is conceivable that rapid healing of severely inflamed Barrett's mucosa with omeprazole may lead to development of carcinoma. We recommend that in this group of patients endoscopic surveillance be done yearly.

This is an educational site created by M. Farivar, M.D. The information provided is the author's opinion based on years of clinical experience and research. You are advised to consult your own physician about the applicability of this information to your particular needs. Also, keep in mind that symptom response to therapy does not preclude the presence of more serious conditions.