Barrett's Oesophagus
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Choccy 76
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Quote Choccy 76 Replybullet Calendar Event: Barretts Length
    Posted: 10 Mar 2018 at 10:12am
Hi there
I was diagnosed with short segment 1cm barretts & IM 3 years ago, I paid for 2nd endoscopy in December 2016 just to check how the barretts was the measurement for this was C1 M1 which was the same as the 1st scan. Last week i had my free 3 yearly NHS scan, the new consultant who was different to the previous consultant i had said whilst doing the scan that the barretts segment was again 1cm & vary small, but when i got the endoscopy report he has marked it down as C1 M2, i am slightly confused by this as i thought that once barretts had formed it tended to stay the same length?
He also said that with it being such a small segment that i may not need surveillance.
Is this correct?

Any help with this would be greatly appreciated

Thanks

Choccy 76
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chrisrob
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Quote chrisrob Replybullet Posted: 10 Mar 2018 at 10:36am
Hi Choccy,

Nothing to worry about here. The endoscopist has just judged the maximum length of a tongue of the Barrett's to be nearer 2 cm than the 1cm previously recorded.

There are very many reasons the recorded lengths can appear to change.

1. The measurements are not very precise. They are assessed by reading the markings on the endoscope's tube where it passes through the mouthguard. These markings are usually about 5cm apart and the endoscopist has to use his judgement for smaller intervals.

2. The oesophagus is not a rigid tube, it's more like a deflated bicycle inner tube and elastic. As the endoscope pushes down it, it can stretch a bit so measurements appear to change.

3. The lower edge is usually the top of the rugae folds demarcating the z-line but this is usually irregular making interpretation of the exact start position slightly variable.

Advice nowadays on scoping suggests that for most people with 1cm or less, scoping may not be required.
The vast majority of scopes are, as far as diagnoses and economics go, an unnecessary waste of time and money - although, of course, the value to the reassured patient is worth it.
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Choccy 76
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Quote Choccy 76 Replybullet Posted: 10 Mar 2018 at 11:06am
Hi Chris

Thanks for getting back to me & putting my mind at rest, This site is great & has a lot of information.
When does the Manchester support group start? & do you have any idea where the meetings will be held?
I may pop down to one of the meetings once they start

Thanks

Choccy 76
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Quote chrisrob Replybullet Posted: 10 Mar 2018 at 11:20am
Attempting to get a date for the Manchester inauguration presently. It should be some time in May and looks like we'll be using the lecture theatre of one of the private hospitals that has better facilities and car parking.
This site, www.BarrettsManchester.org.uk will carry the news when we have it but it'll probably also be posted on this forum and @BarrettsWessex facebook page.

At the initial meeting, we hope to garner sufficient volunteers to form a steering committee. It will then be up to them when and where they can arrange meetings. Barrett's Wessex hopes they will be able to arrange some drop-in sessions but it will take a new committee some time to find its feet.

Edited by chrisrob - 10 Mar 2018 at 11:21am
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Quote Choccy 76 Replybullet Posted: 10 Mar 2018 at 12:17pm
Hi Chris

Thanks for the info, i will look out for this on the site

Choccy 76
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Quote Choccy 76 Replybullet Posted: 12 Apr 2018 at 1:21pm
Hi
I've just received my histopathology report & it states the following:

Barretts C1 M2

Micro: Biopsies of cardiac type gastric mucosa with an area of parietal cells. In one biopsy a small amount of non-keratinzed stratified squamous epithelium is also present. There is no evidence of intestinal meteplasia, dysplasia or malignancy & the lamina propria shows mild oedama & chronic inflimation.

Advised to have repeat gastroscopy in 3 years to confirm the previous findings

Any help with this would be great!!

Does this mean that the barretts area is inflamed with esophagitis?

Also im assuming from this that i am at the lower end of the chances of it turning into cancer with having no IM & small segment length?

Thanks

Choccy 76
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Quote chrisrob Replybullet Posted: 12 Apr 2018 at 3:51pm
OK. Let's try and decipher it for you.

c1m2 (Prague classification) of Barrett's means the affected area is a band around the circumference of the oesophagus, 1 cm deep and a maximum reach of any tongues of 2 cm.

Barrett's is composed of columnar cells ("metaplasia") which may be cardial, or gastric, - resembling the lining of the stomach, or intestinal - resembling the lining of the intestines. The difference being there are some small cells, called "goblet" cells, hidden amongst the columnar ones if it's intestinal. We don't know the role they play but in USA, there has to be evidence of intestinal metaplasia. In UK, and most other countries, cardial or gastric metaplasia is also labelled Barrett's.

The normal surface of the oesophagus should be squamous cells (like the lying down dominoes shown in the domino metaphore in the Down With Acid chapter on Barrett's). Stratified means there may be some extra layers (a thickening) of part of it. These layers can sometimes be of dead cells that haven't yet sloughed away. "Non-keratinized" means they are not dead cells. The only importance of mentioning ths is that it may possibly be an initial stage in the protection of the oesophagus which may lead to more Barrett's cells.

The oesophagus is made of many layers (as shown in the Introductory chapter of Down With Acid). The lining that comes into contact with foods etc is the mucosa (producing mucous to lubricate and protect). The mucosa itself is composed of layers of cells, the base layer of which before you reach the muscle layers, is the lamina propria. There is some infammation and reddening (oedema) here. This shows there is some mild oesophagitis adjacent to the Barrett's cells.

You are correct in believing you are considered at low risk for progression and the recommended surveillance interval would be between 3 and 5 years.

Edited by chrisrob - 12 Apr 2018 at 3:52pm
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Choccy 76
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Quote Choccy 76 Replybullet Posted: 13 Apr 2018 at 7:59am
Thanks Chris
You've been very helpful
Is it common for the barretts samples to have esophagitus & non keratin zed cells?

I was also considering paying for Rfa in the future to burn the barretts off, any idea how much this would cost & is it worth it with there being such a small risk of progression?

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Quote chrisrob Replybullet Posted: 13 Apr 2018 at 9:14am
Oesophagitis is very common: it can lead to the formation of Barrett's cells.
I guess an analogy would be to think of the damage done t your skin if you wear ill fitting shoes. Initially it's a bit sore. It can get red and inflamed. The skin may thicken (as with stratified epithelium) and it may blister. These are the sort of things happening to your oesophagus from constant abrasion/erosion from acid.

RFA is not worth pursuing for a small patch of "ordinary" (non-dysplastic) Barrett's. If your Barrett's were ever to progress to dysplasia, that would be the time to consider having it ablated.

There is a small risk of damage to the oesophagus from ablation. (Something like 1 in 4000 for perforation injury.) It would remove the Barrett's cells but since you have developed it previously, you'd be very likely to develop it again so would need to continue taking acid suppressants and having surveillance scopes as now - so no real advantage.
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Quote Choccy 76 Replybullet Posted: 13 Apr 2018 at 3:52pm
Hi Chris

Thanks for getting back to me you've been very helpful once again

Choccy 76
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