Hello, needallanswers-ga!
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A Word on GERD
http://www.acg.gi.org
GERD, or Gastroesophageal Reflux Disease, occurs when the acidic
stomach secretions come into contact with the lower esophagus. The
stomach has a lining of mucus that tends to protect itself from these
juices, but the esophagus does not, which is why you may feel
“heartburn” when this acid refluxes back into the esophagus. There is
a muscular valve (the lower esophageal sphincter, or LES) that
normally prevents the reflux of stomach acid, but occasionally the LES
opens inappropriately allowing reflux. For more information regarding
GERD, it’s causes, and aggravating factors, refer the patient
information at the American College of Gastroenterolgy’s webpage
(http://www.acg.gi.org/patientinfo/gerd/index.html).
Prolonged exposure to stomach acid in the esophagus can lead to such
problems as narrowing of the esophagus (strictures), bleeding, and a
pre-malignant (“before cancer”) change of the cells lining the
esophagus known as Barrett’s Esophagus. It is these long-term changes
and conditions that lead to a discussion regarding Upper GI Endoscopy.
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Endoscopy in GERD
http://www.medscape.com/viewarticle/450231 (Subscription required, but
access is free)
GERD does not necessarily require endoscopy for diagnosis, but it is
often employed to rule out more serious pathology. Endoscopy is used
also when GERD symptoms do not respond to typical treatment regimens.
The role of endoscopy as a screening tool for Barrett’s esophagus is
unclear:
“Unfortunately, there is little evidence at this time to indicate that
screening for Barrett's esophagus results in the prevention of
Barrett's-related esophageal cancer. Indeed, some experts have begun
to question the validity of the recommendation for screening all
patients with chronic GERD for Barrett's esophagus. However,
performing surveillance endoscopy in patients found to have Barrett's
esophagus through an endoscopic screening program has been associated
with detection of early-stage, curable cancer and improved survival.”
In short, depending on the physician that you consult, you may receive
different answers regarding the need for endoscopy in the face of
Proton Pump Inhibitor treatment (i.e., Prilosec/Nexium)
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Safety of PPIs
http://www.fda.gov/ohrms/dockets/ac/00/slides/3650s1l.pdf
http://www.ukmicentral.nhs.uk/headline/database/printstory.asp?NewsID=2435
Omeprazole (Prilosec) and its “cousin” Esomeprazole (Nexium) are
members of the class of drugs called Proton Pump Inhibitors (PPIs).
These drugs block the secretion of hydrogen ions (the “acid ions”) and
neutralize the stomach secretions. This reduces the amount of stomach
secretions, thereby reducing GERD symptoms. Being fairly new there is
not a lot of information available on long-term safety. The FDA has
presumed its safety based upon the low incidents of serious adverse
events, but has yet to officially declare long-term safety data. There
is a trial being conducted in Great Britain that indicates that safety
data at four years is promising. Most gastroenterologists prescribe
PPIs for long-term use given their excellent results in reducing
symptoms of GERD.
As with all medical advice on this site, it is intended to provide you
with basic information that you can use as a starting point with your
own personal physician. Be sure to discuss the need for long-term
endoscopic surveillance with him or her. Good luck to you and thank
you for your excellent question. If there is any clarification or
information that you still need be sure to ask.
Boquinha-ga
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