Given Imaging, Ltd. Corporate Headquarters Hermon Building New Industrial Park Yoqneam, Israel 20692 Phone 972-4-909-7777 Fax 972-4-959-2466 Diseases of the Esophagus Fact Sheet Esophageal Varices Varices are varicose veins that occur in the esophagus or stomach as a result of portal hypertension, which is a symptom of cirrhosis (severe scarring of the liver). The increased pressure within esophageal varices makes them susceptible to rupture and bleeding. 360 out of every 100,000 Americans have cirrhosis, and gastroesophageal varices are present in 40-60% of cirrhotic patients.1 Due to the high mortality rate (as high as 50%)1 associated with bleeding from esophageal varices, screening of patients with cirrhosis for the presence of varices is recommended by the American Association for the Study of Liver Diseases.2 Treatment options include medical therapy aimed at decreasing portal pressure to prevent variceal bleeding and endoscopic therapy for obliterating varices. Gastrointestinal Reflux Disease Occurs when the lower esophageal sphincter (LES) muscle malfunctions or does not close properly, and stomach acid leaks back into the esophagus, causing a burning sensation in the chest or throat.3,4 Complications of severe or chronic GERD include inflammation, ulcers, and bleeding of the esophagus. Over time, scarring or narrowing (stricture) of the esophagus may occur. A pre-cancerous condition, Barrett’s esophagus, may also develop as a complication of GERD.5 Over the course of a year, up to 60 percent of Americans will experience symptoms of GERD.6 More than 20 percent of Americans suffer from GERD symptoms on a weekly basis.6 GERD is the third-most prevalent disease in the US with the highest annual direct costs ($9.3 billion/year).7 The American College of Gastroenterology (ACG) recommends screening men over age 50 every three years, if they have a history of five years or more of chronic reflux and reflux symptoms at least twice a week Barrett’s Esophagus (BE) BE, a complication of GERD, is a pre-cancerous condition in which the lower portion of the esophagus changes to abnormal cells that resemble normal cells found in the stomach. BE develops in about 10-20% of people with chronic GERD or inflammation of the esophagus.8 GMB-0189-02 w w w . g i v e n i m a g i n g . c o m Evaluating people with a history of GERD can help detect BE; 700,000 adults in the U.S. are reported to have Barrett’s esophagus, which is twice as common in men. 9 The type of cancer that develops from BE is called esophageal adenocarcinoma. A patient with BE has a 0.5% per year risk of developing esophageal adenocarcinoma.3 Esophageal Cancer There are two main types of esophageal cancer. Squamous cell carcinoma can occur anywhere along the esophagus while adenocarcinoma starts at the opening of the stomach and arises only from the cells of Barrett’s esophagus. More than 12,000 people develop esophageal cancer each year in the U.S.,8 and about half of these cases are adenocarcinoma.10 Barium contrast radiography or endoscopic ultrasonography may be used for non-invasive detection of esophageal cancer. However, esophageal cancer is ultimately diagnosed by endoscopy with biopsy. 1. Vargas H. Esophageal Capsule Endoscopy in evaluating varices in cirrhosis: current perspectives on screening. CME program by Arc Mesa and InScope 2. Grace ND. Portal hypertension and variceal bleeding: An AASLD single topic symposium. Hepatology 1998;28:868-88 3. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd 4. http://www.acg.gi.org/patients/gerd/straight.asp#whatisgerd 5. http://www.gicure.com/pated/ecdgs39.htm Jackson Gastroenterology 423 North 21st street Suite 100 Camphill PA 17011 6. Zhao, Y., and Encinosa, W. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005. HCUP Statistical Brief #44. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcupus.ahrq.gov/reports/statbriefs/sb44.pdf 7. The burden of selected digestive diseases in the United States. Gastroenterology. 2002; 122:1500-11 8. John’s Hopkins Medical Institution Gastroenterology & Hepatology Resource Center http://hopkinsgi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease4&organ=2&disease=18&lang_id=1 9. Sampliner RE. Updated guidelines for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2002;97:1888-1895 10. American Cancer Society Webpage www.cancer.org/eprise/”how many people get esophagus cancer” GMB-0189-02 w w w . g i v e n i m a g i n g . c o m