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What Does A Slow Progression Of Barrett's Esophagus Look Like And How Should It Be Addressed?
Question: I have a gastro question about Barretts that i am scared about for Dr. XXXXXXX S Narasi or Dr. Gourdas or a top Gastro doc with lots of knowledge of Barretts esophagus.
Please view my EGD reports in detail from 2013 and 2014. Wasnt my doctor supposed to tell me about this and I have regular surveillance. Is this a slow progression disease, etc. I am really anxious about this doctor.
It seems as if the pathologist and gastro is saying conflicting information.
Please view my EGD reports in detail from 2013 and 2014. Wasnt my doctor supposed to tell me about this and I have regular surveillance. Is this a slow progression disease, etc. I am really anxious about this doctor.
It seems as if the pathologist and gastro is saying conflicting information.
Brief Answer:
Please go through detailed answer.
Detailed Answer:
Hello and thanks for query my dear patient,
Have seen both the reports of year 2013 and 2014.
There is some thing wrong with reporting of report of year 2013.
As you can see by yourself in the very first line it says that changes can be seen and few goblet cells can be seen at gastroesophageal junction, See goblet cells are there in mucosa of stomach. Mucosal layer of esophagus consists of squamous type of cells while the gastric mucosa consist of columnar cells(which are acid resistant).Now let me tell you that hiatel hernia is one of the most common cause of reflux disorder.
So in lay mans language Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation. the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.However in long term it increases risk of adenocarcinoma by 5%.So this is basically a natural protective phenomenon.
Now in reports of 20-13 in the very first line they say it can be barett mucosa.However as explained above XXXXXXX mucosa is nothing but columnar mucosa of stomach.However in the second line of that report they say that there are squamous cells with no significant change.There is something wrong with reporting.
As evident from 2014 reports you have no metaplasia(change of squamous cell into columnar). Mild inflammatory changes are there due to constant reflux of acid.
Nexium 20 mg twice is too low a dose.Secondly nexium is a ppi which prevent acid production.However it has no role in preventing this acid reflux back into esophagus.For that a prokinetic drug should be added like Domperidome or Itopiride 50 mg.
Hope i cleared your doubts well.
Feel free to follow up.
Regards.
Please go through detailed answer.
Detailed Answer:
Hello and thanks for query my dear patient,
Have seen both the reports of year 2013 and 2014.
There is some thing wrong with reporting of report of year 2013.
As you can see by yourself in the very first line it says that changes can be seen and few goblet cells can be seen at gastroesophageal junction, See goblet cells are there in mucosa of stomach. Mucosal layer of esophagus consists of squamous type of cells while the gastric mucosa consist of columnar cells(which are acid resistant).Now let me tell you that hiatel hernia is one of the most common cause of reflux disorder.
So in lay mans language Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation. the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.However in long term it increases risk of adenocarcinoma by 5%.So this is basically a natural protective phenomenon.
Now in reports of 20-13 in the very first line they say it can be barett mucosa.However as explained above XXXXXXX mucosa is nothing but columnar mucosa of stomach.However in the second line of that report they say that there are squamous cells with no significant change.There is something wrong with reporting.
As evident from 2014 reports you have no metaplasia(change of squamous cell into columnar). Mild inflammatory changes are there due to constant reflux of acid.
Nexium 20 mg twice is too low a dose.Secondly nexium is a ppi which prevent acid production.However it has no role in preventing this acid reflux back into esophagus.For that a prokinetic drug should be added like Domperidome or Itopiride 50 mg.
Hope i cleared your doubts well.
Feel free to follow up.
Regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
So are you saying I should not be concerned because report says Barrett’s or cardiac.
So I was never officially diagnosed? It appears as if they are both confused. Operative notes say no sign of Barrett’s in 2013 but pathology says maybe
Also in the 2014 operative notes at the top of the operative report it says History of Barretts which I do not ever recall stating and she even said in her 2013 report negative for Barretts then at the recommendation section of the bottom of 2014 operative report (If the patient has Barretts i will need to undergo surveillance). So those statements alone are very contradiction of one another. It just seems like in 2013 she was unsure because pathology says either Barretts or Cardiac mucosa. Thats why all this is confusing. I just want to make sure with those reports I wasnt supposed to be getting constant endoscopes.
Also could have biopsy been taken too low that’s why the pathologist is confused if Barrett’s or Cardiac
So I was never officially diagnosed? It appears as if they are both confused. Operative notes say no sign of Barrett’s in 2013 but pathology says maybe
Also in the 2014 operative notes at the top of the operative report it says History of Barretts which I do not ever recall stating and she even said in her 2013 report negative for Barretts then at the recommendation section of the bottom of 2014 operative report (If the patient has Barretts i will need to undergo surveillance). So those statements alone are very contradiction of one another. It just seems like in 2013 she was unsure because pathology says either Barretts or Cardiac mucosa. Thats why all this is confusing. I just want to make sure with those reports I wasnt supposed to be getting constant endoscopes.
Also could have biopsy been taken too low that’s why the pathologist is confused if Barrett’s or Cardiac
Brief Answer:
Follow up.
Detailed Answer:
Hello again my dear patient,
Reporting of one of the two reports have been done wrong.
However going by the latest one you don't have XXXXXXX esophagus as no lab will miss changes of XXXXXXX esophagus twice.
Either cardiac or XXXXXXX does not make any sense.Stomach is divided into three part of which first part is called Cardiac.So in XXXXXXX also there would be columnar epithelium and cardiac part is also having columnar cells
However if you want to be 100% sure only way is a third endoscopy with biopsy(Don't show any of these reports to the doctor).
Thanks.
Follow up.
Detailed Answer:
Hello again my dear patient,
Reporting of one of the two reports have been done wrong.
However going by the latest one you don't have XXXXXXX esophagus as no lab will miss changes of XXXXXXX esophagus twice.
Either cardiac or XXXXXXX does not make any sense.Stomach is divided into three part of which first part is called Cardiac.So in XXXXXXX also there would be columnar epithelium and cardiac part is also having columnar cells
However if you want to be 100% sure only way is a third endoscopy with biopsy(Don't show any of these reports to the doctor).
Thanks.
Above answer was peer-reviewed by :
Dr. Remy Koshy
I just want to make sure I’m not outside of that window to recheck. I think I have read 3-5 years for people that have it. Also read that it’s a long process for anything to form
Brief Answer:
Follow up answer.
Detailed Answer:
Hello,
Yes its not possible to miss a simple diagnosis like Barrett's that too twice by endoscopy and once by pathologist.
Symptomatically also a patient with XXXXXXX would have very severe heart burn chest pain regurgitation(which would respond only to high doses of drugs).
As per my experience i would go by 2014 reports.
Regards and feel free to follow up.
Follow up answer.
Detailed Answer:
Hello,
Yes its not possible to miss a simple diagnosis like Barrett's that too twice by endoscopy and once by pathologist.
Symptomatically also a patient with XXXXXXX would have very severe heart burn chest pain regurgitation(which would respond only to high doses of drugs).
As per my experience i would go by 2014 reports.
Regards and feel free to follow up.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I just have bad medical anxiety that something bad has formed since last scope 3 years and 9 months ago.
Brief Answer:
Follow up answer.
Detailed Answer:
Take some lactium(anxiety pills herbal) and just calm down yourself.
Nothing is wrong with you.
Keep taking Proton pump inhibitor in low doses and keep your symptoms in control.
However in case you can't calm your mind just go to a hospital. Donot give any history and see what they report.
Regards.
Follow up answer.
Detailed Answer:
Take some lactium(anxiety pills herbal) and just calm down yourself.
Nothing is wrong with you.
Keep taking Proton pump inhibitor in low doses and keep your symptoms in control.
However in case you can't calm your mind just go to a hospital. Donot give any history and see what they report.
Regards.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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