Dear Doctors: My husband's endoscopy showed a small pinkish area at the base of the esophagus. He has no GERD symptoms, but his doctor has prescribed a big dose of a heartburn medication for life. Is that appropriate for just a small pinkish area? What questions should we ask?
Dear Reader: There appears to be a lapse in communication between your husband and his doctor. He had a procedure to look at his esophagus and was given a vague finding -- an area of pinkish tissue at the base of the structure. It doesn’t sound like he was given a diagnosis or language that is more specific about what’s going on. It’s not surprising that it’s difficult to connect the dots between the test results and the prescribed treatment.
Let's start with the endoscopy. In this procedure, a thin, flexible instrument tipped with a light (and sometimes a camera) is used to look inside the body. When looking at the esophagus, the tube that connects the throat to the stomach, the procedure is known as an esophagoscopy. This may be done when someone has symptoms such as a persistent cough, difficulty swallowing or chronic heartburn. In an esophagoscopy, a lit video camera transmits high-resolution images to a screen. The raw feed can be magnified, processed or enhanced to show granular detail.
When examining the lining of the esophagus, the physician looks at color, texture and shape. In a normal esophagus, color ranges from pale, grayish pink to light pink. Healthy tissues appear smooth and glossy, with a uniform texture. Abnormalities can include areas of inflammation, patches of pale or white tissue, and areas where smooth texture turns rough or granular. The physician is also looking for structural changes, such as thick or narrow areas, and for ulcers or sores.
You appear doubtful about the heartburn medication because your husband shows no signs of GERD, or gastroesophageal reflux disease. The most common symptom is heartburn. However, additional symptoms include cough, trouble swallowing and chest pain. Even the sensation of a lump in the throat can be a symptom. Heartburn medication may be appropriate, despite an absence of classic symptoms.
When it comes to your husband's situation, you are missing an important piece of the puzzle. It would help to know why the endoscopy was done. And without more context, the finding of "a small pinkish area" of tissue is not useful. Whether the doctor rushed through their explanation or failed to give enough details, the result is a treatment plan you don't understand.
First and foremost, your husband needs a diagnosis. What does that area of pinkish tissue represent? Is the prescribed medication meant to heal the area, prevent further damage or reduce risk? Will the treatment be reassessed? If yes, when and how? What could happen if it’s not treated? Successful medical care is a partnership between patient and doctor. With more information, your husband can better understand his condition and participate in his treatment.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
