Riding High: Specialized Treatment Cures Complex Condition

When Tony French, RN, turned 50 last year, he did what many of us are told we should do. He made an appointment with a gastroenterologist for a checkup. “My doctor recommended a full workup since I was experiencing heartburn. This included an upper endoscopy, so he could examine the top part of my gastrointestinal tract for any problems that could be causing my symptoms,” French says. 

Discover Magazine Winter 2018 French
French says that spending time with his horse, Sembagare, keeps him grounded.

During an upper endoscopy, a long, flexible tube with a camera attached is inserted down the throat to examine the esophagus. Once inserted, the lining of the esophagus can be studied for any abnormalities. If necessary, small tissue samples can also be removed for examination in a lab. After the procedure, French was told he had Barrett’s esophagus (BE), a disorder in which the lining of the esophagus—the tube that carries food from the throat to the stomach—is damaged by chronic exposure to stomach acid. BE is common among those who suffer from symptoms of gastroesophageal reflux disease (GERD), which includes heartburn. It occurs most often among white males over the age of 50 and about 10 to 15 percent of individuals with GERD develop BE.

“While the condition itself is not life-threatening, having BE slightly increases the risk of developing esophageal adenocarcinoma, an aggressive form of cancer,” says A. Stephen Fleisher, MD, chief of Gastroenterology and director of Interventional Endoscopy at the Center for Digestive Disease at MedStar Franklin Square Medical Center. “That’s why it’s important for individuals diagnosed with BE to have regular exams to detect precancerous cells.”

French also had low-grade dysplasia, the earliest precancerous stage of BE in which a few of the cells in the epithelial tissue lining the esophagus develop abnormal features. He was put on acid reflux drugs, called proton pump inhibitors or PPIs, to try to reduce the inflammation and scheduled a follow-up endoscopic procedure. A few months later, a second endoscopy revealed that his condition had progressed. He now had high-grade dysplasia, a further step on the precancerous continuum of tissue changes before the development of cancer. His doctor referred him to Dr. Fleisher. 

Discover Magazine Winter 2018 French
When he is not riding, French works as a nurse at MedStar Good Samaritan Hospital.

“The Center for Digestive Disease is leading the charge for conditions requiring advanced intervention for MedStar Health in the Baltimore region,” says Dr. Fleisher. “Here, we have nationally recognized physicians who are dedicated to providing highly specialized, extensive, and compassionate patient care for a full range of digestive system disorders, including the most complex.”  Dr. Fleisher is one of a handful of specialists in the region trained to treat patients with BE using radiofrequency ablation or RFA, which works by using heat to destroy precancerous cells. “Before RFA, non-surgical treatment options were limited,” Dr. Fleisher notes. “And with few effective treatments, many patients faced major surgery to remove all or part of the esophagus. RFA can actually prevent the development of cancer.”  

The RFA treatment is most effective when the lining of the esophagus is smooth. In French’s case there were nodules that would interfere with treatment. So Dr. Fleisher first used a procedure called endoscopic mucosal resection to remove the dysplastic tissue. He then eradicated the remaining abnormal cell growths using RFA. “RFA, performed on an outpatient basis, is a FDA-approved, minimally invasive treatment that involves inserting a small balloon catheter into the esophagus, and, once it has been correctly positioned, delivering radiofrequency waves into the esophageal lining, causing a thermal injury or ‘burn,’” Dr. Fleisher explains. “The diseased tissue is destroyed, and healthy esophageal tissue is formed as a part of the natural healing. RFA eliminates BE in the majority of patients with two to three treatments.”

Discover Magazine Winter 2018 French
French, who competes in riding competitions, trains with his horse several times a week.  When he is not riding, French works as a nurse at MedStar Good Samaritan Hospital.

“I had a little discomfort with swallowing after one of the procedures, but it was temporary. My Barrett’s esophagus is gone, and I feel good,” adds French, who, when he is not riding his horse Sembagare, works as a nurse in the medical/surgical unit at MedStar Good Samaritan Hospital. “Dr. Fleisher was great … he was meticulous, he communicated well, and I could tell he was truly interested in helping me.” French continues to take acid reflux drugs to prevent his heartburn from recurring and sees Dr. Fleisher regularly for checkups.

The Center for Digestive Disease at MedStar Franklin Square has been recognized by U.S.News & World Report as high performing in gastroenterology and GI surgery. The center specializes in offering patients and their referring physicians non-invasive and minimally invasive robotic surgery options to reduce complications, decrease hospital stays, and reduce health risks so patients and their families can regain their lives sooner.

Featured in Discover Winter 2018 Magazine

Location Information

For a physician referral, please call 855-546-0794.

MedStar Franklin Square Medical Center
Center for Digestive Disease
9000 Franklin Square Drive
Baltimore, MD 21237

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Dr. Linda Rosenthal and Dr. John Covington also see patients in the Towson area at:
 
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Suite B
Lutherville, MD 21093

FAST FACT

Barrett’s esophagus occurs most often among white males over the age of 50 and about 10 to 15 percent of individuals with gastroesophageal reflux disease develop it.