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MarieD
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Quote MarieD Replybullet Topic: Barrett's follow up normal and don't want PPIs
    Posted: 07áJulá2018 at 3:30pm
 I did not have any known symptoms of reflux/acid except for one 30 day period about 9 years ago until last year.  Reflux began again last year after I had a really bad cold with lots of deep coughing for a few weeks.  Had an endoscopy after that and diagnosed with Barrett's. Have been taking PPI's since then and also lost some weight which brought my BMI below 25. Had follow up endoscopy recently and biopsies came back as normal.  Now, I'm not as concerned about the Barrett's as I am about the PPI's.  There are some nasty consequences of long term PPI use and I really want to get off them. But, my doctor says PPI's should be taken forever with a Barrett's diagnosis.  Also no good answer about the 'normal' diagnosis other than maybe in the area of the biopsy (3 specimens) it didn't show up.  I would like to transition from the PPI's to an H2 blocker (like Ranititidine).  BTW, I know this is anecdotal but I read some  studies about use of Black Raspberries reducing Barrett's, studies included large doses of the Black Raspberries.  I've been taking Black Raspberry powder for the past year every day. Don't know if that had any real effect or not.
Two questions:
Anyone have advice from doctors about being able to use H2 blocker instead of PPI?  And, anyone have situation where a follow up biopsy comes back as normal and if so  what did the doctor advise?
Thanks for any help, Marie
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steveb8189
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Quote steveb8189 Replybullet Posted: 08áJulá2018 at 11:06am
Hi Marie
There is plenty of speculation online about the long term use of PPIs but I am yet to see any peer reviewed research that confirms any of the claims are true. PPIs have been used for many years and are considered to be one of the safest drugs available on the market. PPIs have also been shown to reduce the risk of progression from Barretts to cancer - something that has not been proven for H2 blockers. Are you experiencing any specific side effects that are encouraging you to change? I didn't get on very well with emsoprazole as it made me lethargic but moving to lansoprazole solved that problem.

As for the biopsies, it's probable that it just didn't show up.
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chrisrob
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Quote chrisrob Replybullet Posted: 08áJulá2018 at 11:39am
Hi Marie and welcome to the forum.

Your bout of acid reflux nine years ago may have been what triggered the production of the Barrett's cells which could explain why you felt you were symptom free since. Barrett's cells may be thought of as armour plating thrown up by the body to protect against acid erosion. Being less sensitive than the squamous cells they protect, you are less likely to feel acid splashing into the oesophagus.

Acid reflux has the two main components of acid and reflux. Reflux of anything from the stomach up the oesophagus may breach the upper sphincter (correctly termed extra-oesophageal reflux) which may actually have been the cause of, or contributory to, what you considered a bad cold.

Congratulations on losing weight. That is the single most effective thing we can do to reduce reflux. (You will also find other lifestyle modifications to help reduce reflux in the Down With Acid encyclopaedia here.)

I cannot comment on the "normal diagnosis" as I don't know the full circumstances. It could be the gastroenterologist considered it "normal" as your Barrett's was unchanged? (That's the most common scenario.) If he meant there was no evidence of Barrett's, there could be many explanations. It could be the first diagnosis was incorrect. It could be the endoscopist failed to find Barrett's cells. It could be new mucosal cells have grown over the Barrett's cells, hiding them. It may also be to do with reclassification. In UK, Barrett's is defined as any columnar cells in the oesophagus, which can be gastric or cardial (resembling the stomach lining) or intestinal (resembling the intestines). In US, Barrett's has to be intestinal by definition. Some gastroenterologists seem to be using the US definition nowadays. However, if you did have Barrett's previously, you still will have: it doesn't just go away.

You say only 3 biopsies were taken which seems to indicate the size and area is small. (The normal protocol for taking biopsies is to take 4 (quadrantically) every 2 cm over the length of the lesion.)

Regards the PPIs.
There are many scare stories, most of which are totally unfounded. See
this chapter in the Down With Acid book and there are more recent studies showing the efficacy and probable chemo-protective effect of PPI medication - so it is best to stay on them.
H2 blockers are not so effective as PPIs. Until the latest research paper, H2 blockers had not been found to offer the chemo-protection of PPIs. The latest paper does credit H2 blockers with a decreased risk of 30% against PPIs reduced risk factor of 41%.

If you do decide to try H2 blockers instead of PPIs, you will probably be prescribed 300mg daily to be taken in two doses as they are only effective for 12 hours.

If you find dried raspberries helpful for you, there's probably no harm in taking them as a supplement to your medication, rather than an alternative to it, but there is no evidence it actually helps and do mention it to your doctor. (There is a chapter on natural remedies in the Down With Acid book.)

All the best
Chris
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MarieD
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Quote MarieD Replybullet Posted: 08áJulá2018 at 2:12pm
Thanks for the reply Steve.  I'm still leery of long term effects of PPIs.  There are some studies that do find side effects of the drug.  This article from 2016 on WEBMD summarizes some of those.
https://www.webmd.com/heartburn-gerd/news/20160608/proton-pump-inhibitor-health-risks#

Marie
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chrisrob
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Quote chrisrob Replybullet Posted: 08áJulá2018 at 2:27pm
Most of those risks have now been disproved.

I am actually presently collecting and collating all the latest research evidence for and against PPIs for two new "Burning Questions" factsheets which will also inform the next edition of the Down With Acid encyclopaedia if it is reprinted in about a year's time as presently predicted.

Meanwhile, read the chapter on Controversy over long term medication in that book but there have been a few new papers on the subject since that was printed last year.

It is right these drugs come under scrutiny as they are the most commonly prescribed drugs, in use by millions worldwide for 30 years But they are amongst the afest drugs around and are robably saving countless lives.
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MarieD
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Quote MarieD Replybullet Posted: 08áJulá2018 at 2:29pm
Thanks for the reply ChrisRob.  Actually the biopsies were sent to a pathologist who came back with the 'normal' diagnosis.
I didn't know about the normal protocol of taking biopsies.  The gastroenterologist's report says "the maximum longitudinal extent of the mucosal changes was 0.5 cm in length".  Don't know if that was why he did only the 3 -  I'm going to ask the doctor why.  I also need to get his operative report from a year ago and see what he said then.
I do understand that there are competing studies/papers about whether PPIs cause other ailments. So, whose to know which are correct and which aren't. 
BTW, it isn't just raspberries - it is black raspberries which are virtually impossible to find or grow.  At least they're high in antioxidants, so they do some good.





Edited by MarieD - 08áJulá2018 at 5:22pm
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steveb8189
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Quote steveb8189 Replybullet Posted: 08áJulá2018 at 7:35pm
It may be that with only 0.5cm there just wasn't enough to biopsy. A maximum length of 0.5cm may mean it is not circumfrential - did you get an official classification e.g. C1M2?

Imagine what 0.5cm actually looks like and then imagine sampling it holding a pair of scissors from 40cm away!

Edited by steveb8189 - 08áJulá2018 at 7:36pm
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MarieD
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Quote MarieD Replybullet Posted: 08áJulá2018 at 8:43pm
No classification code.
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