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Saz10
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Quote Saz10 Replybullet Topic: Another endoscope
    Posted: 27áNová2016 at 8:01am
Hi
I went for another endoscope last week after being diagnosed with non IM Barrett's in January. More recently I have been suffering more symptoms of pain in my chest and an irritation feeling inside. I had sedation during the procedure so I felt fine during the endoscope.
The consultant came to see me after the endoscope and said my oesophagus was inflamed. Visually he did not think I had Barrett's. There were some small areas that he took biopsies to exclude oesophagitis and esinophillis oesophagitis.

Could any of you help understand the report I have been sent in the post.
There is an irregular Z-line with toungues of CLO less than 1cm (2 biopsies).
In the oesophagus superficial membranes at 30cm (biopsies 30 and 22cm X 2 to exclude EoE or other inflammatory causes)
Pales areas in the Antrim (biopsies x2) and biopsies in the gastric body to exclude H.p (endofaster positive for H.p)
EF pH was 4.2 suggesting only partial control of gastric acidity.
He has prescribed Esomeprazole 20mg twice a day.
I am really confused as back in January I just had a possible diagnosis of Barrett's, now i seem to have damaged my oesophagus by being on PPIs (20mg omeprazole, then 30mg Lansoprzole), eating a very healthy diet, only drinking water and def green tea occasionally, eating small meals, definitely not overweight (7st 7lb). And back in July the results from a pH manometry/test showed no acid reflux (the consultant said they are going to repeat this test)
And to top it off - I don't even feel sick anymore, which was the main reason I was sent for an endoscope in January.
Can something else be causing this damage to my oesophagus.
Any help/advice would be great as I really don't understand what is going on and would like to ask the Professor a lot of questions when I go back for a clinic appointment.
Thanks
Sarah
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Saz10
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Quote Saz10 Replybullet Posted: 27áNová2016 at 8:26am
Forgot to say aswell.
The consultant also said I do not have a HH. The consultant who performed my pH manometry/test in July said the same. Can they rectify themselves as I was told I had a 2cm HH during two previous endoscopes (one in January and one about 9yrs ago)
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chrisrob
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Quote chrisrob Replybullet Posted: 27áNová2016 at 10:01am
Hi Sarah,

Sometimes difficult to diagnose anything accurately when there's a lot of inflammation. oesophagitis, HH, Barrett's can all be confused in a red haze.

However, let's try and decipher your report.
The Z-line is where the soesophagus meets the stomach - the delineation between oesophageal mucosa and gastric mucosa. It is frequently not a regular line but zigs and zags a bit - described as tongues. CLO = "Columnar Lined Oesophagus" (= Barrett's).
Some of the inflammed area has caused some extra membranes to form which were tested (presumably negatively) for EoE.
Some pale areas tested (again presumably negatively) for the bacterium, H-Pylori.

20mg omeprazole is equivalent to 30mg lansoprazole. Both are the low maintenance dose. Ovioulsy this has been insufficient and your consultant has doubled this - and changed you to esomeprazole for some reason.

The most likely cause of the reflux that has carried acid into your oesophagus (despite what your earlier pH manometry test appeared to show) would be a Hiatus Hernia. If not too large, these can resolve themselves with good posture and cautious management. Or the HH may still be present but difficult to detect visually because of the inflammation.

Hope the higher dose of PPI works to resolve the excess infammation.
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Saz10
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Quote Saz10 Replybullet Posted: 27áNová2016 at 10:17am
Thanks Chris.
Could I just further quiz you if that's ok. The consultant at Cambridge Hosptial who performed the endoscope is very experienced. I don't understand why he has said visually he doesn't think it's Barrett's but CLO (written on my report) represents Barrett's. So if the biopsy comes back with not IM, does that mean I don't have Barrett's (even though CLO = Barrett's.
I want to be sure what I'm asking the Professor when I go for my clinic appointment.
Also, do you know how long it should be before the increase in medication should have a effect. I've been on the increase medication for about 5 days now but still getting the irritation feeling after eating absolutely anything.
Thanks
Sarah
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chrisrob
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Quote chrisrob Replybullet Posted: 27áNová2016 at 10:57am
We're entering a rather grey area about the definition of Barrett's. In UK, Columnar Lined Oesophagus has always been the accepted definition of Barrett's. It is also described as metaplasia meaning the normal (squamous) cells have been replaced by these columnar ones. In US, those columnar cells have to be identified as Intestinal Metaplasia (ie resembling those found in the intestines) rather than Gastric Metaplasia (resembling those found in the stomach). (The difference is actually to do with the presence of "goblet cells" - which describes their appearance.) It could be easy to biopsy the wrong side of the z-line, or from an area of hiatus hernia, which would show normal gastric columnar cells which could be mistaken for metaplasia. (Interestingly, a very recently published paper questions whether Barrett's can actually exist below the z-line - so the discussion continues.)

Once the acidity is reduced sufficiently, the inflammation should reduce and your oesophagus heal usually over two to three weeks. (Think about how long it takes for a scar to heal if you were to have grazed your knee.)
All the best
Chris
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jcombs99
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Quote jcombs99 Replybullet Posted: 27áNová2016 at 1:16pm
S
     It's really hard to do a good EGD .U didn't damage ur O by PPI's ur drug and dose didn't do the job (blood red) so he changed them.To bad he didn't do that last Jan. then do a EGD in 60 days for another look not wait 10 months so a wasted 10 months .I bet U have a small HH BUT they can change sizes mine gos from 3 to 4cm .It's the doctor's opinion by LOOKING not by measuring so there is error there too. I had a barium X-ray and that doctor told me I didn't have a HH see the broad range of opinions .Take the drugs and wait to see what the biopsies show and hopefully he didn't take them below the Z-line .Great fun isn't this and I had HGD .Ask for more tests and take the samples to another path department for another opinion like I do if u have the funds .
    Ur lucky ur not paying 4 them my first doc did 2 in 2 weeks BOTH were done wrong and I got billed 2x plus all the wasted time and PROFIT on his part a real pig.

CHEERs

Edited by jcombs99 - 27áNová2016 at 1:53pm
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