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Zippypop
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Quote Zippypop Replybullet Topic: Histology
    Posted: 19 Feb 2019 at 5:45pm
Having read on a social media page a situation very similar to mine, I think some pathologists do need to be more clear, especially given that the patient can read their findings.

My report (similar to one I spotted) states the words. "Consistent with but not diagnostic of".

It's not a yes or no and leaves people in limbo kind of.

Does it mean, they think it is barretts but this particular biopsy doesn't confirm it or does it mean, the endoscopy looked like it, but the biopsies proved it wasn't. For info my area was around 1cm too (described by my specialist and nothing to worry about) However that's easier said than done if you have to wait years until the next check...

I have asked my GP but he is as much use as a chocolate fire guard.


No metaplasia or dysplasia was found on these biopsies (x2). Official diagnosis was squam ocolumnar mucosa with chronic inflammation of the gastric cardiac type showing fovelar hyperplasia. Is this esophagitis or/and gastritis?

I am rather confused

Thankyou
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chrisrob
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Quote chrisrob Replybullet Posted: 19 Feb 2019 at 6:28pm
Problem is it's a very small area to survey just at the junction of the stomach and oesophagus.

Let's start at the end and work back.

No dysplasia is the best bit. No metaplasia means all cells were appropriate for their position.
Foveolar hyperplasia is inflammation at the oesophago-gastric junction (OGJ). It can be oesophageal cells (oesophagitis) and/or gastric (cardial) cells (gastritis).
The report says it's the gastric cardia type - so cells below the z-line (OGJ).

Squamo-columnar mucosa means the mucosal layer has squamous cells, as would normally be found in the oesophagus (above the z-line), and columnar cells which would normally be found in the cardia of the stomach (below the z-line).

Barrett's cells are columnar cells. However, these columnar cells harvested at the OGJ are probably cardial rather than oesophageal, so the impression is they are consistent with Barrett's but not diagnostic of it.

For an area that small with the descriptor you have received, it's possible they could decide a surveillance schedule may not actually be needed - except, of course, you want to know whether there have been any changes.

If you take your acid suppressant medication, the inflammation will have a chance to heal. A further scope in a few years may find nothing.
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Zippypop
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Quote Zippypop Replybullet Posted: 19 Feb 2019 at 7:07pm
Chrisrob

Many thanks for the quick and in depth response. Forums like these along with your knowledge are invaluable.   I suffer with anxiety so often think , did they take enough biopsies, or did they take from the correct area. I suppose I just have to suck it up and wait for the next check
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Quote chrisrob Replybullet Posted: 20 Feb 2019 at 11:31am
Anxiety can be a very real issue for those of us with Barrett's, that's so often ignored by consultants.

See this page from the forthcoming revision of Down With Acid.
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Quote Zippypop Replybullet Posted: 20 Feb 2019 at 2:37pm
I do wonder due to the chronic inflammation if things have been missed. I suppose I should be glad it was a very small area and have to convince myself the gastroscopist biopsies the correct area?
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Quote Zippypop Replybullet Posted: 22 Aug 2019 at 10:41am
Chris,is it normal for cells to harvest at the OGJ?

And by the diagnosis is it actually barretts or not?
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Quote chrisrob Replybullet Posted: 26 Aug 2019 at 9:40am
Barrett's forms adjacent to the OGJ or z-line. If harvested below, biopsies would be of the stomach. The columnar cells are identical to gastric metaplasia which in UK is termed Barrett's Oesophagus. This is where misdiagnoses can occur. The demarkation isn't a clean line: the squamous cells give way to gastric cells with some overlap. If the z-line is irregular, the harvested cells are gastric type and the area of Barrett's is less than 1 cm, it may not be classifiable as Barrett's at all.
The US definition requiring the observance of goblet cells which distinguishes intestinal metaplasia, goes some way to obviating this discrepancy.
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