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Northbriton
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Quote Northbriton Replybullet Topic: Information greatfull received
    Posted: 02 Nov 2015 at 1:09pm
I have had for most of my adult life Indigestion and Hearburn.In 1999 I was put on omaprozole 40mg daily. These kept the hurting symptoms away but I do suffer from sore throat in a morning and a productive cough.About a year ago I went to see my GP who sent me to an ENT Doctor who recommended I also take Gaviscon regulary which I do..
About 12 weeks ago I started to feel nauseous and billeous as well as having lower back pain and aching testicles which put me off my food.My GP gave me Metoclopramide for the sickness and put my back pain down to muscle/skeleton issues The sickness tablets did not work and I started to lose weight because I couldn't face food and indeed one day I was violently sick.I went back to the GP who took blood and urine samples which came back clear.Eventually after numerous GP visits I was put on the 2 week Cancer track which meant I was to have an endoscopy and a ct scan as well as a chest x ray.
The endoscopy was taken first and my GP rang to tell me the news that all was fine with it (more later).The ct scans came back and the GP reception (not the GP) rang to say that all was fine. I was obviously still feeling sick and asked what I was supposed to do next and was given another prescription this time for Pregnant women Morning sickness pills.
The Endoscopy Doctor then sent me my results from my procedure and I quoute "The camera test other than slight change in the inner lining at the bottom end of the gullet (Barrett's oesophagus) does not report any significant abnormality and the biopsies do not report any worrying cells" We will see you in gastroenterology in due course...
I have the photographs of the endoscopy and one of them shows a red area with the notation "tongue of oesophagitis? Barrets - Biopsy taken.
My questions please are these:
Is it safe to assume than my Barretts is not at this moment dangerous?
Can Barretts cause the feelings of nausea and sickness that I have been suffering from for about 3 months?
My hospital consultant is now on extended holiday to mid December so I cannot speak with him.
My GP seems to be unconcerned with my state and has given me no reason for my as yet unexplained feelings of Nausea.
So in summary I am worried by my condition and need to know if after 15 years on omaprozale they have done me no good in stopping reflux.Should I have an operation to stop the reflux or continue on my tablets and hope my barretts gets no worse?.Sorry for rambling a little in this post but I am worried - and as yet I feel my medical people are not treating my symptons as anything sinister and are doing nothing to address my very many concerns over my sickness and Barretts diagnosis.I am male 60 years old.
Any help greatly appreciated
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jcombs99
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Quote jcombs99 Replybullet Posted: 02 Nov 2015 at 2:27pm
North
   When are UK doctors not on leave I can get mine 24/7 ?
1) Been on same drug and dose since 1999 !!!!!! NO WAY !! that can work ..
2)YOUR doctors spent way to much funds on you should've been Endoscope FIRST !!! they get results NEXT morning if need be like my doctor does .Then spent $$$$$$ on you..
Read Chris's Ebook like 5x.. .Sounds like you have all kinds of Reflux which can make you very sick like the end is coming or you want it.
I HOPE the tests turn out well mean while work on Drug,Diet,..and get a PH test .

CHEERs

HGD(Look that up ) Jeff
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chrisrob
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Quote chrisrob Replybullet Posted: 02 Nov 2015 at 3:28pm
Hi North and welcome to the forum.

I was on omeprazole from 1994 rising to 80mg daily over between 2004 and 2008 (when I had a fundoplication).
PPIs like omeprazole are good at controlling acid hyper-secretion but do not control reflux which, even if non-acidic, is the cause of the cough.

There are two drugs commonly used to help control nausea and regurgitation with Barrett's / GORD patients: domperidone is supposed to help peristalsis of the food bolus from the oesophagus into the stomach and metoclpopramide is supposed to aid peristalsis of chyme from the stomach into the duodenum. Some find them helpful. Like you, I didn't.

The oeosphagitis that shows red on the photo means acid has probably still refluxed. Barrett's should be salmon pink but it can be difficult distinguishing the two depending upon whether it was viewed under normal white light or a different lighting system.
Biopsies will define whether the inflammation is Barrett's or not and whether it is non-dysplastic (which is most likely). If there were any signs of possible "danger" from your Barrett's, you would know fairly quickly. Generally, the longer they keep you waiting for results, the less "dangerous" it's likely to be.

There has been recent research that indicates PPIs probably have a chemo-protective effect Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis concludes "Based on meta-analysis of observational studies, the use of PPIs is associated with a decreased risk of OAC and/or BO-HGD in patients with BO. None of the studies showed an increased risk of OAC."

It may be difficult to control reflux. There are no drugs for this, only lifestyle advice. In my case I decided fundoplication was the answer. And it also reduces the risk of progression to cancer: Antireflux Surgery and Risk of Esophageal Adenocarcinoma: A Systematic Review and Meta-analysis. concludes "Antireflux surgery may prevent EAC better than medical therapy in patients with Barrett's esophagus."

Read the chapter on extra-oesophageal reflux in the Down With Acid book or website and also take a look at the NICE option grid in the book's appendices for pros and cons of PPIs vs fundoplication.

Best of luck
Chris
P.S. you may read my experiences of fundoplication on my personal blog here.
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Northbriton
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Quote Northbriton Replybullet Posted: 02 Nov 2015 at 7:27pm
Thank you for your very detailed information Chris. No one told me what the Metoclopramide was supposed to do. If its to help the digestion process quicken up then it would have been nice to have that explained.
I today rang the hospital and have been told a follow up appointment is in 6 weeks..
The endoscopy photograph shows more of angry red like a burn than a salmon pink colour.
Thanks for the reassurances.I assume that as you mention the sickness drugs prescribed that after some time of having reflux and potential associated Barretts that the nausea and sickness can creep up and then becomes chronic.I wonder then that it not unusual for people with my condition to be on anti nausea tablets as well as PPIs?
After 40 odd years with reflux issues and 16 of those years on medication with no review or follow ups apart from when my coughing and sore throat got so much worse that now is time to get the situation resolved.I fully intend that 2016 will get things moving. Pleased I found this forum. Never heard of Barretts until 2 weeks ago and it is good to find that I am not alone and that I can get answers and experience from fellow sufferers

Cheers again
North
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chrisrob
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Quote chrisrob Replybullet Posted: 03 Nov 2015 at 10:31am
By the time of your follow up appointment, your biopsy results will have been returned from the histopathologists. Each of the samples will have been set in paraffin wax and sliced very finely creating hundreds of slides which each need to be examined under a microscope by eye looking for the cell shapes and markers (goblet cells) that identify the Barrett's metaplasia and hoping not to find dysplasia.
As you can imagine, this can take a long time especially if the workload is backing up but they'll prioritise any considered suspicious.

Doctors don't like prescribing Metoclopramide and Domperidone unless necessary. The body starts becoming used to them and they start losing the effectiveness requiring increasing the dosage. Unfortunately increased doses come with side effects linked to an increase in heart arythmias. Metoclopramide is a prescription only drug whereas domperidone is still available as a pharmacy drug ("Motillium") for purchase from a pharmacist.
The European drugs agency last year, however, did provide warnings of the harmful side effects and recommended domperidone was made prescription only.
Many people do not find either of these drugs very effective. There was a third drug, Cisapride, that was more effective. (I was on it about 20 years ago). However, it has been withdrawn from European and American markets due to its links with increased risks of arythmia and atrial fibrilation.
A new drug that has been recently approved in Japan, Acotiamide, shows promise as a better pro-kinetic and new research has uncovered the role of Bombesin in lower oesophageal contractions which may pave the way to better reflux reducing medication eventually.

Most people have never heard of Barrett's Oesophagus. The charity I co-founded, Barrett's Wessex, has as its principal aim "to reduce the number of deaths to oesophageal cancer through raising awareness of its predominant pre-cancerous lesion, Barrett's Oesophagus".
Last February, the NHS funded Be Clear On Cancer campaign, which has famously highlighted other cancers with their "Blood in Poo" messages, focussed on Oesophageal cancer. Using that as a precedent, Barrett's Wessex and some of the other charities within the Action Against Heartburn consortium, have decided to recognise February as oesophageal cance awareness month and urge as many people as possible to use that month to spread the word about Barrett's Oesophagus.

A facebook campaign was launched last January to educate people about their oesophagus. The "Point To Your Oesophagus" was created originally solely for that campaign but it has been decided to retain it for future Oesophageal Cancer Awareness months and will be revamped.
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phil-uk
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Quote phil-uk Replybullet Posted: 25 Nov 2015 at 10:40pm
Hi Northbriton, Sometimes it can seem that there is little we can do, physically, to help alleviate the symptoms of reflux. We cannot, for example, choose an concious exercise program to strengthen the LOS, as we might do to strengthen an arm.

 I have, however, found two very useful 'therapies' that seem to help my condition, and improve my sense of self-help and empowerment.

1, Belly breathing, or Diaphragmatic Breathing. I do this when-ever and where-ever I can.
2, Forms of exercise that get me out of breath. I do cycling. This helps increase feelings of fitness and well-being.

There is loads of info on Diaphragmatic breathing online if you do a search. Try here for a start...

https://en.wikipedia.org/wiki/Diaphragmatic_breathing

In 2012 a small clinical trial reported benefits for those with reflux...

http://www.ncbi.nlm.nih.gov/pubmed/22146488

Phil-uk


Edited by phil-uk - 25 Nov 2015 at 10:45pm
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Northbriton
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Quote Northbriton Replybullet Posted: 12 Dec 2015 at 3:28pm
Well.. after an appointment arranged with consultant for mid Dec to discuss symptoms and results,this appointment was rearranged for end Jan. I have now received a letter informing me yet again rearranged and now for end February. A tad worrying as I don't know what stage my Barretts is at.. It will have been 4 months since my gastroscopy I have to assume that all is ok otherwise I would have been called back sooner.. (wouldn't I???)
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jcombs99
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Quote jcombs99 Replybullet Posted: 12 Dec 2015 at 4:14pm
Who knows and I hope your fine .That's what I hate about the NHS why don't they CALL or email you . I was fogged in so I changed my scope and then they changed it again DAYs not months .
I would call you my be the ODD one with trouble or the test report fell on the floor .
My sister was @ Mayo Clinic to check her colon NEXT day they were cutting it out .I'm old I need good healthcare .

CHEERs

Edited by jcombs99 - 12 Dec 2015 at 4:22pm
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chrisrob
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Quote chrisrob Replybullet Posted: 12 Dec 2015 at 4:20pm
Hi North. We all know how the NHS is being squeezed with funding cuts and increased expectations.
But if it was considered urgent, you would have had an earlier appointment.
I would deduce your results are fine - probably showing only non-dysplastic Barrett's.
At Southampton, we have what's called a "virtual clinic" whereby clinic or GP follow up appointments are not provided unless necessary but we receive the details by letter, phone or email and can phone or email if we have concerns. It does save time and travel to a clinic appointment.
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teacher man
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Quote teacher man Replybullet Posted: 12 Dec 2015 at 8:05pm
I agree, belly breathing does help. And rather quickly for myself.
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