UNC Hospitals Offers Innovative New Treatment for Barrett's Esophagus

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Treatment for Barrett's Esophagus

The University of North Carolina Hospitals is one of a limited number of medical centers nationwide to offer photodynamic therapy to treat Barrett's esophagus, a condition that can lead to cancer.

"Photodynamic therapy opens up a treatment option to older patients for whom surgery would be too risky," said Dr. Nicholas Shaheen, director of the Center for Esophogeal Diseases and Swallowing at UNC. "It is also a much less invasive option than surgery for selected younger patients."

As many as 2 million adults in the United States have Barrett's esophagus, which stems from a much more common condition called gastroesophageal reflux disease, or GERD. Barrett's esophagus predisposes people to develop adenocarcinoma of the esophagus, a cancer which effects about 8,000 people a year in the United States.

People with Barrett's esophagus often experience GERD symptoms such as heartburn, regurgitation of stomach contents and, in some cases, difficulty swallowing. Over time, repeated exposure to stomach acid and enzymes causes the normal lining of the esophagus to be replaced by a lining similar to that found in the intestines. Currently, more than 400 people with Barrett's esophagus are being treated at UNC.

Until recently, the only active treatment option available when Barrett's esophagus progressed to pre-cancerous lesions or cancer was removal of the esophagus, a major surgery that carries a 5-10 percent chance of death and the possibility of serious complications, including frequent nausea and vomiting, that decrease the patient's quality of life. The average age of onset of this cancer is in the patients' 70s, and surgery is often too risky for patients in that age group, especially if they have developed other medical problems. In addition, following the surgery, called an esophagectomy, patients may experience complications such as pneumonia and other infections.

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Photodynamic therapy, or PDT, offers a less invasive alternative to an esophagectomy in patients with precancerous changes or very superficial cancer. In PDT, the patient is first given an injection by intravenous drip of a drug called porfimer sodium, which is sold under the brand name Photofrin. The drug causes the patient's tissues to be much more sensitive to red light. Then, usually about two days later, an endoscope is used to shine a red laser light on the affected areas of the esophagus.

"What you're doing with the light is activating the medication, which essentially burns the lining of the esophagus, to destroy the Barrett's cells," Dr. Shaheen said. Then, as the esophagus heals, a normal esophageal lining replaces the Barrett's lining, he said.

The U.S. Food and Drug Administration approved Photofrin PDT for treatment of pre-cancerous lesions in Barrett's esophagus in August 2003, after a clinical trial showed that patients treated with Photofrin PDT had a 13 percent chance of having cancer 18 months later. In comparison, patients who did not receive Photofrin PDT had a 28 percent chance of cancer.

UNC Hospitals performed its first PDT procedure for Barrett's esophagus in fall 2004 and has since performed about 20 additional PDT procedures involving 12 patients. To date, nearly two years after FDA approval, only about 64 medical centers nationwide have used PDT to treat Barrett's esophagus, according to Axcan Scandipharm Inc., the company that manufactures Photofrin.

Persons who have or think they may have Barrett's esophagus and would like to be evaluated at UNC Hospitals may call (919) 966-2513 to request an appointment.

CHAPEL HILL, N.C. - UNC Hospitals

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