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paulb
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Quote paulb Replybullet Topic: ADC without Dysplasia
    Posted: 09 Dec 2012 at 4:59pm
Hi,

My reading has led me to understand that you can still develop ACD even in the absence of any form of dysplasia. Admittedly this is significantly less frequent (0.2% per patient year) than with LGD or HGD but it does appear to happen.

Is this your understanding too ?

The initial information one finds implies that there is ALWAYS a progression through LGD, HGD before ACD.

This could be slightly misleading.

If my interpretation is correct why would anyone, at a personal level, not choose RFD as soon as a diagnosis of BE has been made ? ( assuming finance is not an issue)

I can understand the NHS position because it concerns itself with the health and cost implications of a population and NOT the individual.

Would welcome your thoughts.....

Paul
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chrisrob
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Quote chrisrob Replybullet Posted: 09 Dec 2012 at 5:43pm
Hi Paul,

I find this interesting. Where did you find that information?

There is much research and discussion regarding the mechanisms of change from Barrett's to OADC but the consensus opinion appears to be that dysplasia is a necessary step along the way because of the changes in cellular structure - from flat plates (squamous) to columns (metaplsia) to fallen columns (LGC) to disorganised columns (HGD) to complete disorder (neoplasia & OADC).

This book (download of the now closed site written by the Ryan Hill Research foundation) - BarrettsInfo.pdf, describes the normally accepted view of that progression (pages 36 onwards).

Chris
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jcombs99
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Quote jcombs99 Replybullet Posted: 09 Dec 2012 at 6:13pm
Paulb
   I'm sure your correct I read something about this 6 or 8 months ago it was addressed a NEW way to get OC which no one knows . I'm not good on links ect. so I didn't pass it on BUT it stated it would happen right by the LOS .You should look into this I'm sure most doctors don't know about this . Just like barretts 6 yrs ago .. Remember it's all about the money or the lack of it ...

Edited by jcombs99 - 09 Dec 2012 at 6:20pm
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paulb
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Quote paulb Replybullet Posted: 09 Dec 2012 at 7:53pm
http://jnci.oxfordjournals.org/content/103/13/1049.long

The above link covers the study in Northern Ireland.

There are several places where they state/imply that the risk is higher in LGD patients than those with no dysplasia..

However, they do group ADC and HGD together as a single result. Therefore they could be stating that the risk of acquiring HGD s higher, or ACD, or both.

It could also be they believe there can be very rapid progression through the interim steps.

It's not entirely clear.

If you have the time and inclination I'd appreciate it if you could give it a read and see what you think.

Thanks,

Paul
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chrisrob
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Quote chrisrob Replybullet Posted: 10 Dec 2012 at 11:47am
Thanks for the link, Paul,

This study echoes the findings, produced about the same time, from a Dutch study suggesting risks are not as great as had been previously suspected. [I cannot find the link at the moment.]

If the progression from Barrett's Oesophagus to adenocarcinoma follows the route; squamous -> metaplasia -> LGD -> HGD -> neoplasia, as is normally accepted, it would follow that the further along that progression line a patient is, the greater their risk of contracting OADC.

Just last week, the American College of Physicians published new guidelines for endoscopic surveillance based on the fact that progression isn't that common (and there are always risks associated with endoscopy).

In UK, the BOSS trial is currently evaluating the need for regular surveillance.

However, as someone with Barrett's, and understanding the risk of adenocarcinoma is very small, however unpleasant I find the experience of an endoscopy, I would prefer to have the reassurance every couple of years that it hasn't progressed to something more sinister.

All the best

Chris

Edited by chrisrob - 10 Dec 2012 at 11:49am
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