Barrett's Esophagus

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Gastroenterologist: 410-955-4910 +
To See a Gastroenterologist with Expertise in Barrett's Esophagus and Treatment of Gastroesophageal Reflux Disease
The American Gastrroenterologic Association advises that individuals who have had reflux symptoms (usually heartburn) for several years undergo upper endoscopy to determine if Barrett's esophagus is present and to assess for premalignant features. This is accomplished by insertion of a flexible fiberoptic tube (endoscope) through the mouth into the esophagus. A computerized camera/ visualization system attached to the endoscope allows the gastroenterologist to determine if Barrett's esophagus is present and this is confirmed by biopsies. Biopsies are also examined to detect dysplasia, the precursor to cancer. In experienced hands, upper endoscopy is a simple, painless, low risk procedure requiring less than an hour without need for inpatient admission.

If you have reflux symptoms or know you have Barrett's esophagus or dysplasia in Barrett's esopgahus, and would like to be evaluated at Johns Hopkins, the appropriate gastroenterologists are Dr. Marcia Canto and Dr. William Ravich.

Dr. Canto received her medical degree in 1985 and completed her internship and residency in Internal Medicine at the State University of New York Health Sciences Center in Brooklyn, New York. After training as a Gastroenterologist at Johns Hopkins, she added an advanced endoscopy fellowship at Case Western Reserve University in Cleveland, where she remained on staff until 1996, when she joined the full-time faculty at Johns Hopkins. She has subsequently earned a degree in Clinical Epidemiology from the Johns Hopkins School of Hygiene and Public Health. She is Board Certified in Internal Medicine and Gastroenterology.

At Hopkins, she has become a leading national expert in the evaluation and treatment of Barrett's esophagus and chemoprevention in Barrett's esophagus and is the endoscopist on clinical trials in this discipline. She has performed thousands of endoscopic procedures and is a pioneer in using special dyes to detect abnormal areas in the esophagus (a technique which is called chromoendoscopy). She is the author of numerous publications on esophageal diseases and has lectured nationally and internationally on these topics.
Medical Oncologist: 410-955-8964 +
To See An Oncologist at Johns Hopkins For Cancer of The Esophagus or High Grade Dysplasia of the Esophagus
There are two oncologists at Johns Hopkins specializing in the care of high-grade dysplasia and cancer of the esophagus. Dr. Elisabeth I. Heath and Dr. Arlene A. Forastiere. They are both Board Certified in Internal Medicine and Medical Oncology and are participating in trials involving treatment of esophageal cancer and high-grade dysplasia in Barrett's esophagus.

Dr. Heath is an attending medical oncologist. She received her M.D. degree from Jefferson Medical College and completed her internal medicine training at Georgetown University Hospital and subsequently trained in Medical Oncology at Johns Hopkins. Her primary interest is in developing and conducting clinical trials utilizing novel agents for patients with cancers of the esophagus and lung. She also has an interest in chemoprevention and has been instrumental in the design and leadership of a multi-center cancer prevention trial for patients with Barrett's esophagus.

Dr. Forastiere is a Professor of Medical Oncology who has served on the Johns Hopkins medical staff for over ten years. She has participated in numerous clinical trials involving esophageal cancer and is an author on numerous scholarly publications in this area. Drs. Forastiere and Heath initiated the proposal for the cyclooxegynase-2 inhibitor trial in Barrett's esophagus patients that is now ongoing. The objective of the trial is to prevent esophageal cancer since its incidence is increasing at an alarming rate in the United States. They have done this in collaboration with the Gastroenterologists and with the Johns Hopkins School of Hygiene and Public Health and has received peer-reviewed funding for approximately 5 million dollars.
Surgeons: 410-933-7495 +
To See a Surgeon at Johns Hopkins for Cancer of the Esophagus, High-Grade Dysplasia of the Esophagus, or Surgical Treatment of Gastroesophageal Reflux Disease
When choosing a surgeon, it is also particularly important to select a hospital where a large volume of esophagectomies are performed for the safest care. In fact, a recent study published in the New England Journal of Medicine proves that esophagectomy is significantly safer in hospitals performing a large number of esophagectomies than in hospitals performing only a few such procedures annually [N Engl J Med 2002; 346: 1128-37]. Johns Hopkins Hospital performs a large number of esophagectomies annually.
Pathologists: 410-955-8964 +
To Have Your Biopsy Slides Reviewed by a Pathologist at Johns Hopkins
If you have been told you have Barrett's esophagus or dysplasia (pre-cancerous tissue) in Barrett's esophagus, you may wish to have a second opinion on your slides. Since many pathologists have limited experience with interpreting these biopsies, it is often recommended that a second opinion be sought before a patient undergoes treatment, especially when dysplasia is identified. In fact, the inter-observer agreement (agreement on the diagnosis between pathologists) for the diagnosis of low-grade dysplasia is only about 70%.

The team of Gastrointestinal Pathologists at Johns Hopkins has extensive experience with interpretation of slides from patients with diseases of the esophagus.

» Get a Pathology second opinion.