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.