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NickH
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Quote NickH Replybullet Topic: No BO or HH?
    Posted: 27 Feb 2018 at 6:51pm
Hi,
Diagnosed 3 years ago with 3cm BO and Hiatus hernia and also IM.
Had a second endoscopy at the 2 year mark after I kept hassling, no changes.
Sometime later started to notice reflux increasing, upped the PPI dosage to 40mg of Omeprazole as per GP recommendation. Reflux appearing to get more constant so got my GP to get another endoscopy arranged, this would have been a year after the 2nd one where no change was noted.

Went for a chat with my consultant today who said that the most recent endoscopy showed no BO or HH? Esophagitis was noted however which confirms my smyptoms of reflux. I questioned the consultant about saying the BO had gone, he agreed that it can't go but said it may be that the original diagnosis was wrong? Drew me a little picture explaining how it can be difficult to tell what bit is stomach lining and what is the oesophagus.
I also asked him about the IM diagnosis, he said that again this could be the biopsy being taken from the stomach which is where these cells normally reside.

I told him that I've got the lump in the throat sensation pretty much all the time, he said 'globus' was not a result of reflux, something that goes against everything I've read on this site. He suggested trying different meds to combat the reflux globus and/or reflux symptoms. Reckoned there was no point in suggesting particular dietary routes as he felt people are better as self diagnosing what causes reflux for them and what doesn't, kind of agree on that one really, still in the process of trying to work that one out for myself.

As much as I'd like to believe the consultant I suspect that he's being too dismissive (said he's discharged me but to come back in 4 years just to make sure). I appreciate that the oesophagus can move about during an endoscopy and if a small segment is found, as in my case, then it would be easy for it to disappear on subsequent investigations. Question is though does that mean it can be incorrectly diagnosed in the first place? I saw the pics from my very first endoscopy and I could clearly see the damage, particularly on the pics where the Dr has used a special dye to highlight scarred tissue. I'm sure this damaged tissue is still there but surely a consultant should have read my complete medical history before making his conclusions today?

Any advice much appreciated please!

Thanks
Nick
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steveb8189
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Quote steveb8189 Replybullet Posted: 28 Feb 2018 at 2:49pm
Hi Nick
Was your original diagnosis based on the results of biopsies? Did they retake biopsies and still find BO after 2 years?

All sounds rather peculiar.There is evidence to show that normal squamous epithelium can grow over the top of the Barrett's cells making making them harder to see on endoscopy and less likely to be picked up in the biopsies. What's strange is that you still have the reflux and esophagitus which suggests it would have been quite hard for the normal cells to regrow - especially over a 3cm length.

Personally I would be going back in 2-3 years
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chrisrob
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Quote chrisrob Replybullet Posted: 28 Feb 2018 at 3:11pm
Hi Nick,

Yes it does sound a strange case. Whereas a new epithelial layer can occur, it sounds unlikely in this case.
Assuming the latest scope and histology is accurate, it's likely the previous ones weren't.
I do know how difficult it is to assess biopsy slides particularly when precise indication of position of origin may not be accurately known.

The damage you could see on yur photos from the first scope may have just been oesohagitis which has been allowed to heal with the use of acid suppressants.

As regards the lump in the throat, I'd still be inclined to think it's globus. A few years ago, I discussed "dry eys" as a possible symptom of reflux with one of our consultant gastroenterologists. He said there was no connection and that when someone with a particular condition gets symptoms from another condition they may assume they're connected. However, I showed a possible connection (via nasal cavity and tear duct) and conducted a survey of refluxers to confirm my views and since then, I have read a couple of research papers that also confirmed my original belief.

My most recent surveys informing my paper, "Prevalence of Extra-Oesophageal Reflux symptoms amongst acid refluxers and perceived efficacy of regular medication and reflux reduction intervention", shows 50% of refluxers experience globus.
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NickH
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Quote NickH Replybullet Posted: 01 Mar 2018 at 4:05pm
Hi Steve

Biopsies were taken on the 2nd endoscopy with no change noted which I guess means BO still there?

The reflux has only really become more noticeable over the last 6 months to a year to I suppose there's a possibility that healing may have been taking place prior to that.

I agree, 4 years feels to long, especially as I seem to have almost constant reflux symptoms, I'll be hassling them much sooner for sure!
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NickH
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Quote NickH Replybullet Posted: 01 Mar 2018 at 4:39pm
Hi Chris

Thanks for the link, the findings are fairly conclusive, surgery being the logical option if PPI's aren't improving reflux which appears to be in my case.

When I had my first endoscopy, the GP told me that the Dr who had made the original diagnosis was very good at spotting BO and said I was lucky she did it as other Dr's may well miss it.

I get the impression that I may need to become an annoying pestering patient to push for a suitable solution. As much as I don't relish the thought of surgery I certainly don't want to increase damage already done from acid plus living with reflux symptoms every day takes it toll on general well being. Am findings it very difficult to identify what makes the reflux worse, often just waking up in the morning is enough to get it going!


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chrisrob
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Quote chrisrob Replybullet Posted: 01 Mar 2018 at 4:58pm
I delayed having surgery far too long. I'd been offered it in 1997 but it would have been open surgery then and was too scared. (It's now usually keyhole). I eventually had it in 2008. It was the best thing I ever did.

Of course, surgery isn't the answer for everyone and they'll need to do a 24hr pH manometry test (or 48hr Bravo) to check first.

This page on the Barrett's Wessex website has links to patients' 'warts and all' recounting of their experiences of the surgery.

All the best
Chris
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