Health Matters: Scope proceduresDr. Joshua Wynne answers the question: When shoul I have a scope procedure?
By: Dr. Joshua Wynne, Grand Forks Herald
Q. I am a 46-year-old woman with a several year history of heartburn and have been diagnosed with GERD. My family history is positive for cancer, and I’m worried. Should I have a scope procedure?
A. GERD stands for gastroesophageal reflux disease, a common ailment caused by stomach acid irritating the lower portion of the food tube (esophagus). It affects over 100 million Americans and usually can be treated effectively with any one of six different medications called proton-pump inhibitors or PPIs; brand-name examples include Protonix and Nexium.
These medications are available in prescription form or are sold over the counter. As your question indicates, one of the concerns with GERD is that it is associated with a greater risk of cancer of the esophagus, which has increased in frequency over the past four decades. Passing a tube, or endoscope, down the esophagus allows the doctor to look at the lining of the esophagus for any abnormality and to take biopsy specimens to be sure that cancerous change is not present.
The hope is that by finding early cancerous changes in the esophagus treatment can prevent late-stage disease and death. So those are the potential benefits of having a scope procedure, or endoscopy. Yet most of us would advise you against having the procedure! Why? Because your risk of esophageal cancer turns out to be exceedingly low.
Eighty percent of esophageal cancer occurs in men who are usually over the age of 50. A 46-year-old woman like you is very unlikely to have esophageal cancer. Who then should have a scope in the setting of GERD? Men over the age of 50 years who are smokers and overweight with reflux symptoms that are severe, prolonged, or associated with alarm symptoms such as weight loss, bleeding, anemia, or sticking food certainly should be evaluated promptly and undergo an endoscopy. There are other situations where a scope may be helpful. But for most patients whose symptoms are well controlled with medication, endoscopy usually is not required.
Q. I’ve been reading about those people who died of meningitis after receiving an injection of contaminated medicine. Any update?
A. This is the second time in the past decade that there has been an outbreak of this kind. Both episodes involved the injection of a corticosteroid, used to reduce inflammation, in which the medicine appears to have been contaminated by a fungus.
Fungi involved in human disease are microorganisms that cause infections that can be difficult to treat and usually only occur in individuals with impaired immune systems. Thus it comes as no surprise that these outbreaks involved contamination of a medication that suppresses the immune system. Over 14,000 patients may have been exposed to the ill-fated medicine in the current outbreak, and about 600 have become infected.
Because fungal infections are slow to develop, it may take up to six months after injection with the contaminated medicine for infections to become evident. In the first episode in 2002, an antifungal medication was effective in treating the infection.
Nevertheless, the mortality rate in that outbreak was 20 percent, and it is running about 6 percent in the current outbreak. Exactly how the fungi were able to contaminate the corticosteroid medication in the current outbreak remains unclear. Fortunately, no health care facility in North Dakota received any of the contaminated product, but some was shipped to Minnesota.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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