Barrett's Oesophagus
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Message Icon Event: New BE diagnosis and Hiatal Hernia - Event Date: 14 Dec 2019 Post Reply Post New Topic
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Grahamlev
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Quote Grahamlev Replybullet Calendar Event: New BE diagnosis and Hiatal Hernia
    Posted: 14 Dec 2019 at 7:32pm
Hello All,

I have recently been diagnosed with Barrett’s, a 4cm Sliding HH in the LO, Diverticular Disease, A low White Blood Cell count and last but not least haemangiomas on the liver. All in the space of about 2 weeks post Blood Test/CT scan/MRI and both endoscopy and colonoscopy.

Symptoms were persistent heartburn, coughing after eating, changing bowel habits and stomach cramps.

Needless to say it’s been a whirlwind and in shock in trying to digest and process all of the news. We have a consultation with the Gastroenterologist next week to check the biopsy results and get the full diagnosis on all of these conditions bar the bloods which I have a follow up in Jan. I was told the Barretts is of a 4cm long length in the Prague Range C0 and M1.

I decided to post after finding the forum very informative, namely Chris’ thorough responses, and comforting as Dr Google makes one feel that the inevitability of cancer from Barrett’s is only a matter of time.

I am a non smoking 41 year old male from Kent in the UK who for 10 years has had a good Med style diet and only been symptomatic for 2-3 months now. I exercise several times a week and am in what could be deemed a ‘Normal’ weight range.

Needless to say the diagnosis was frustrating and scary to begin with and until we get the full Biopsy results then the levels of uncertainty tend to fluctuate. Particularly when the symptoms flare up having taken the suggested diets for GERD to the letter and cutting all of the ‘bad’ food and drinks.

I urge anyone who is having any of these symptoms to get checked if in any doubt what to do as not knowing is part of the mental challenge that no doubt effects the physical health too.

It’s human nature of course to look for solutions before getting a qualified diagnosis so if the Prague class is an indicator of the potential diagnosis and eventual prognosis then any expert opinion would be welcome.

Good luck one and all
Graham

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chrisrob
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Quote chrisrob Replybullet Posted: 15 Dec 2019 at 11:18am
Hi Graham,

I don't know whether it was the endoscopist or your doctor but if your Barrett's is classified as c0m1, the Barrett's tongue is only 1 cm not 4.
But it's often misrecorded and measurements cannot be precise as they are estimated from markings every 5 cm on the outside of the scope and recorded at the point where it enters the tooth guard. And the scope is a semi rigid instrument being pushed down against a flexible tube that may stretch.

You may read more about Prague Classification here.

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Grahamlev
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Quote Grahamlev Replybullet Posted: 15 Dec 2019 at 7:28pm
Thanks for taking the time to reply Chris.

Just re-reading my report again you are correct yes, the Hiatal Hernia is described as sliding 4cm and the endoscopist classed it as C0 M1.

In your experience then does the size of the Barrett’s tongue bare any reflection on the potential for dysplasia or should I not read too much into that and just wait for the results of the Biopsies?

I appreciate that until I see the consultant on Thursday then a lot is speculative but any information would be appreciated.

I hope this next question makes sense too. Does taking control of the hiatal hernia(plus diverticular disease in my case) through lifestyle and diet Reduce the levels of acid reflux thus could slow the rate at which the Barrett’s tongue grows and/or becoming dysplastic?

I have been on a pretty strict diet for the last few weeks but still suffer from heartburn while I try to figure out what food or drinks could be causing it.

Rather than rely on just medication and hope I would like to face this and do everything in my power to now control the situation rather than get too down about it all.

I have read you were diagnosed some years ago so it is heartening to read your history and how you dealt a with it.

Thank you kindly
Graham




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chrisrob
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Quote chrisrob Replybullet Posted: 16 Dec 2019 at 10:00am
Graham,
You have a very small patch of Barrett's; it does not form a collar but only a patch less than 1cm.

Barrett's is made up of newly-formed acid resistant cells to protect the oesophagus against erosion. These cells do not multiply so the area will not spread. You would only get a larger area of Barrett's if more were made in response to continued acid attack.

The area of Barrett's will have hundreds of cells; because they are not normally found in the oesophagus, each has the ability to mutate. The more cells, the more chance but the chances are very small. UK has the highest risk where about 1 in 400 will develop the cancer each year. However, this figure isn't cumulative and over a lifetime it is estimated the risk of Barrett's becoming cancerous is about 10%. BUT that is for those who don't know it.

There are many reasons why Barrett's will form but the principal one is reflux of acid and bile, as explained here.
To reduce the acid, acid suppressants (PPI medication) needs to be taken. Stomach acid is produced by the action of hormones; acidity of foods does not alter the acidity of the stomach, nor does acid cause reflux so diets are actually ineffective - apart from losing weight or avoiding anything that may trigger your heartburn (which is caused by material passing over extant oesophagitis).

Those of us with Barrett's are the lucky ones. PPI medication has been shown to reduce the risk of mutation (See "Can PPIs protect against cancer?") and regular surveillance every few years will look for pre-cancerous changes (dysplasia) whence it may be ablated.
As shown here, Surveillance intervals depend on the severity and area of your Barrett's and body build and familial history may also be taken into account. With such a small area, they may even decide the risk of mutation is so small surveillance scoping may be unnecessary. There is a risk (about 1 in 2000) of damaging the oesophagus during endoscopy. If you are not offered regular surveillance, you will still be able to ask for a repeat scope in a few years time if you have reason for concern.

The longer we have had Barrett's, the less likely it is to mutate to cancer (I guess our bodies become used to the extra cells being there?)
(Cancer Risk in Barrett's is Mainly Early)

Summary:
Your Barrett's is permanent and will remain unchanged. If acid continues to reflux, there is the possibility of more Barrett's being formed. To reduce this risk, PPIs reduce acid and lifestyle modification will reduce reflux.

Cheers
Chris
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