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njd2
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Quote njd2 Replybullet Topic: Reversability
    Posted: 13 Jul 2017 at 5:21pm
Hello all!

I'm new to the forum... FYI I have HH of 2cm and 5cm barrets, age 29.

I was diagnosed 2 years with HH of 2 cm and Barretts of 3cm, I was initially on low dose of omperozol which kept it at bay for 18 months, the last 6 months have been a nightmare…tried every medication under the sun, currently on 300 mg rinatine, 80mg esomeprozol and 30 mg metoclopramide and still needing to take max dose of gaviscon advance and tums most days!!

The Gastroenterologist (forgive poor spelling!) has finally referred me to a surgeon for a fundo. I have been told 12 weeks to see the surgoen followed by 20 weeks until the surgery. Is this normal?

I have read a lot of negative things on here about ‘Fundos’ – should I be put off?

At one stage I lost a lot of weight and was very controlled and at that point my acid was much better. Admittedly in the last 6 months I have not been as well controlled but still relatively controlled (i.e. no fizzy drinks etc). Should I go superstrict on a diet to see if that will make any difference? (At this stage if I cut out any more all I will be eating is small portions of chicken/pasta and protein shakes!).

One last question…. One thing I’ve not been able to get a firm answer on – is barretts reversible if you keep acid away for a number of years? Or just possible to stop it getting worse?

Sorry for the long post – I’ve followed this forum for a while and thought best to finally ask some of the questions I can’t seem to get opinions on elsewhere!!

Thanks in advance
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chrisrob
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Quote chrisrob Replybullet Posted: 13 Jul 2017 at 6:21pm
Hi N and welcome to the forum.

I can sympathise. I, too, have 3cm Barrett's for at least 23 years and probably a lot longer.

Like you, none of the medication was stopping my symptoms. But I realised they were from reflux rather than acid. The PPIs (omeprazole etc) are excellent reducing acid but don't stop the reflux. The metoclopramide may help some people to a small degree but was useless for me, as was the other frequently prescribed anti-emetic, domperidone.

I was initially offered a fundoplication 20 years ago but was too scared. (It would have been open surgery then. The laparoscopic technique was still in its infancy.)
I tried to manage on omeprazole which was gradually increased to 80mg a day for the last few years but induced hypochlorhydria resuted in my becoming anaemic and yet more medication (iron tablets) added to my daily regimen.

Ten years ago, I'd had enough. However bad the operation was, it must be better than the awfulness of what I was going through. I, too, had read all the bad reports but went ahead anyway.
It was the best thing I ever did! I wish I'd done it sooner. All my reflux symptoms (some of which I hadn't realised were reflux) disappeared overnight and I was immediately off all medication.

You may read my experience (and those of some others) on the Barrett's Wessex website.
The wait time is quite normal, I'm afraid. The surgery is classed as "elective" which puts it beneath "emergency" and "essential" in terms of priorities. (I had to nag for mine.)

From the Down With Acid book: "A study published in Surgical Endoscopy in 2014 reviewed the durability of Laparoscopic Fundoplication over 20 years and concluded, "Long-term results from the early experience with LF are excellent with 94 % of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18 % required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90 % of patients are happy to have had LF."

There's a lot of rubbish spoken about diet. As far as acid hypersecretion and reflux are concerned, diet makes no difference (unless you have identified a trigger food pertinent to you to be avoided).
See the section on Food in the Down With Acid book.

Sorry, but Barrett's is not reversible. It used to be thought it could be but that was before we learned more about it.
It is now believed to develop as a new entity (from stem cells rather than mutation of existing cells) as the body's reaction to the reflux of acid and bile in an attempt to protect itself. Think of it as a friend as described here.

Some people claim their Barrett's has gone away but those claims are due to various possible reasons: the original diagnosis may have been wrong or, more commonly, a new mucosal layer has formed over the Barrett's hiding it.

Do read the Down With Acid book for a better understanding about acid, reflux, complications and management and ask as many questions on here as you like.

All the best
Chris
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njd2
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Quote njd2 Replybullet Posted: 14 Jul 2017 at 8:59am
Wow - a very comprehensive and useful reply. Thanks very much Chris.

I'll have to sit patiently on the waiting list for now.

If Barrett's is not reversible, why don't more people have it removed when having a fundoplication? Surely if there is a risk of it turning nasty that would be more worthwhile?
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njd2
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Quote njd2 Replybullet Posted: 14 Jul 2017 at 9:00am
Additionally, is there any long term discomfort from the surgery? I currently feel like I have a squash ball in my chest from the HH, does this go away after the fundo?
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chrisrob
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Quote chrisrob Replybullet Posted: 14 Jul 2017 at 10:53am
It's not worth doing RFA for Non-Dysplastic Barrett's Oesophagus.
The risks of progression for NDBO are too small. And, of course, there are risks with RFA. (eg perforation of the oesophagus.)

If you have already developed Barrett's previousy, having it ablated doesn't mean it won't develop again so you'd still be required to take medication (if you need it after your fundo) and have regulat surveillance scopes as before.

Had no long term discomfort from fundo. Though I had to have revision after my wrap came loose from 5 hours violent retching due to norovirus and received the more invasive Collis-Nissen. (The Collis part resections the stomach to effect a longer oesophagus below the diaphragm around which to make a more secure wrap.) The more invasive surgery meant my stomach is smaller and I have to be particularly careful with eating (small amounts, slowly) as it can dump into the duodenum prematurely ( = "Dumping Syndrome" which can cause an insulin reaction similar to a diabetic; on 3 separate occasions I have suddenly blacked out from this.
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Mtmurray
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Quote Mtmurray Replybullet Posted: 14 Jul 2017 at 12:13pm
I had a fundo 5/5/2016. It's a laparoscopic procedure, so there isn't any large incisions . It is an abdominal surgery where they are manipulating your atanomy to prevent reflux. The first 3 days you're in a fair amount of pain and discomfort. The meds help with that. The two post surgery things that took a while to go away were 1. Numbness and tingling around my incision sites 2. I felt different where the did the wrap. It's hard to explain, but it just felt strange. That all went away and now I feel normal. I am off ppi and have had no reflux since the procedure. It's the best thing I've ever done. If I had to do it again tomorrow, I would
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njd2
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Quote njd2 Replybullet Posted: 14 Jul 2017 at 1:10pm
That 'dumping syndrome' sounds quite nasty - is having a smaller stomach quite common if you need to have a second fundo?
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njd2
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Quote njd2 Replybullet Posted: 14 Jul 2017 at 1:12pm
Additionally, given that I am only 29 - guess there is a fairly high chance that at some point I'd need a revision?
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chrisrob
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Quote chrisrob Replybullet Posted: 14 Jul 2017 at 1:51pm
Not everyone needs a redo. Of those who do, not everyone receives a Collis procedure. Of those who do, few get the dumping - it's more common for oesophagectomy. For those who do get dumping, most find it resolves within a few months.

I do still have to be careful over 3 years later, but a few months after my redo, I cycled over the Andes and last year through Burma.

I will stress that had absolutely no problems after my first fundo. Within a matter of weeks, I was cycling 20-30 miles every morning before breakfast then cycled through France, Holland and Vietnam and Cambodia.

Despite the discomfort after eating I get frequently, I'm really pleased with my revision.

My blog of my "refundo" may be read here.
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Mtmurray
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Quote Mtmurray Replybullet Posted: 14 Jul 2017 at 3:18pm
I agree with Chris, my life is 100% normal. I ride 3 days a week and lift 3 days a week. I do everything except dead lifts or abdominal workouts. I'm 36 and don't care if I need a revision. It brought normalcy back to my life
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