More Information
WHAT IS A COLON POLYP?
Your doctor may have recently told you that you have a colon polyp. It may have already been removed or destroyed during a colonoscopy. The information below will answer questions you may have about this condition.
A colon polyp is extra tissue that grows on the inside of your colon (or large intestine). A colon polyp can be benign (non-cancerous) or malignant (cancerous). Benign polyps are most commonly found in the colon, but both benign polyps and malignant polyps should be removed.
Anyone can get polyps, but certain factors cause you to have a greater chance of getting polyps. These factors include:
- If you are over 50 years old
- If you have had polyps in the past
- If someone in your family has had polyps
- If someone in your family has had colorectal cancer.
Colon polyps are found in one of two shapes. Polyps on stems or stalks look like mushrooms and are called pedunculated. When they grow directly onto the inner wall of the colon like spilled paint, they are called sessile and are much more difficult to remove.
What are symptoms of polyps?
Most small polyps do not cause any symptoms. Often people learn they have polyps after their first colonoscopy. Some people do experience symptoms which can include:
- Bleeding from the rectum. You may notice blood on the toilet paper after a bowel movement.
- New onset of either diarrhea or constipation that lasts for more than one week.
- Blood in the stool. Blood in the stool will give the stool a black appearance or streaks of blood in the stool.
- There might not be any sympotoms.
Once you have had polyps removed your doctor will want you to have future colonoscopies. The frequency of these exams will depend upon the pathology of the polyps and your symptoms.
BARRETT’S ESOPHAGUS
Barrett’s esophagus is a condition in which the esophagus changes so that some of the lining is replaced by a tissue that is similar to tissue normally found in the intestine. This is called metaplasia. Barrett’s may not cause any symptoms, a small number of people with this condition may develop a relatively rare cancer of the esophagus, called esophageal adenocarcinoma. Barrett’s esophagus affects about 700,000 adults in the United States. Overall, only 0.5% of people diagnosed with Barrett’s will go on to develop esophageal cancer. It is associated with the very common condition gastroesophageal reflux disease or GERD. To help digest food, the stomach produces large amounts of hydrochloric acid every day. This powerful acid can begin to digest a piece of meat in a short time, but amazingly does not damage the stomach. Because the stomach has a specialized cells that line it to protect it from the acid. The esophagus does not have the same type of protective lining that the stomach has
What Are The Symptoms?
There are no true symptoms of Barrett's, but most patients have a history of GERD and complain of heartburn or indigestion, occurring at least two times a week. Other symptoms may include: difficulty swallowing food, waking up at night because of heartburn, persistent unexplained cough, or hoarseness. If you have these symptoms, you should be checked for Barrett's. Unfortunately, some patients with Barrett's have very little heartburn and no warning, even though they have significant damage.
How Do I Know if I have Barrett’s Esophagus?
Screening for Barrett's Esophagus requires a esophagogastroduodenoscopy, or upper endoscopy examination to directly visualize the lower esophagus and determine if there is any damage. This is painlessly done under conscious sedation. During this exam, samples, or biopsies, can also be taken to confirm the presence of Barrett's and to check for pre-cancerous changes, or dysplasia.
What if I do have Barrett’s?
Once Barrett's Esophagus is identified, doctors have several treatment options available. The first step is to stop acid reflux and prevent further damage from occurring. This can usually be accomplished with daily doses of medications called proton pump inhibitors (PPIs); some common brand names are: Prilosec, Prevacid, Aciphex, Protonix, and Nexium which reduce your production of stomach acid. For these medicataions to work effectively it is important that you take these medications 30 minutes prior to eating breakfast. Even when the symptoms subside it is important to continue the medication. Improved symptoms DO NOT reverse the damage to the cells of your esophagus. Follow up endoscopy is needed at least every one to two years.
Treatment Choices
- There are two types of surgery performed in cases of Barrett's. If no dysplasia is present and symptoms of acid reflux do not respond to intensive medical therapy, surgery may be necessary to retighten the loosened lower esophageal sphincter, thus preventing further acid damage. This operation does not remove the area of Barrett's which still must be periodically rebiopsied. In the past, this procedure required open surgery with a full incision and a prolonged recovery period. Newer less invasive techniques now allow a much simpler procedure with several mini-incisions and a shortened recovery period. If the condition is identified at a later stage, patients may require surgery to actually remove part of the esophagus and pull the stomach upward to the remaining portion. This is a more radical operation, but totally removes the area of Barrett's.
- In this procedure, special light-activated dyes are given intravenously which makes the area of Barrett's especially sensitive to laser light. This allows selective destruction of the area of Barrett's lining without damaging the entire esophagus. The area becomes ulcerated and is treated with medication. In most cases, when the ulcer heals, it is replaced by the normal esophagus lining and not the abnormal stomach lining.
- This device is passed down through the center channel of a gastroscope. The tip has a computer controlled heating device that burns the tissue it contacts. This device has been used for many years in the treatment of bleeding ulcers and is now being tested in patients with Barrett's. One great concern with these new destructive techniques is that not all of the Barrett's cells will be destroyed and some may hide under the newly formed lining with a potential for future cancer. Surveillance should be continued after treatment
- EMR is useful when the Barrett's changes only involve a short segment (less than 2 cm). Using the gastroscope and a suction device, the inner layer of a portion of the esophagus is cut away. This often allows normal cells to replace the Barrett's tissue.
Surgery
Photodynamic Therapy(PDT)
Thermal Ablative Therapy
Endoscopic Mucosal Resection (EMR)
Colon polyps are found in one of two shapes. Polyps on stems or stalks look like mushrooms and are called pedunculated. When they grow directly onto the inner wall of the colon like spilled paint, they are called sessile and are much more difficult to remove.
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Often, the symptoms of GERD occur after meals. Another common term used for GERD is heartburn.Common foods such as fried or fatty foods, tomato products, citrus fruits and juices, chocolate, or caffeine-containing products can produce these symptoms. In severe cases, almost any food seems to cause symptoms. Usually the burning-type chest pain lasts for many minutes and is often made worse after lying flat or bending over. Sometimes a gnawing sensation awakens an individual from sleep. Relief is usually obtained by standing upright or by taking an antacid.
What are the complications of GERD?
Continuous inflammation over a long period of time may cause scar tissue to build up in the esophagus, narrowing the opening, causing a stricture and making it difficult to swallow solid food. This may require special dilatation to allow normal swallowing function.
When GERD goes untreated over a long period of time, acid reflux from the stomach can cause cells lining the esophagus to change. This can result in Barrett's esophagus. The risk of cancer of the esophagus is increased in people who have Barrett's changes. For this reason, they require regular checkups by their physicians.
When should you see your physician about GERD?
Not everybody who experience GERD needs to see their physician. If the symptoms are frequent, severe, or progress, seek medical attention. If you have GERD symptoms, ask yourself these questions:
- Do you take antacids two or more times a week?
- Do you take GERD medicine(s) other than antacids?
- Does your GERD interfere with your daily activities?
- Do these symptoms often occur after meals?
- Do these symptoms interfere with your sleep?
- Do you find that your medicine only relieves your symptoms for short periods of time?