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Rodrigo Ribeiro
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Quote Rodrigo Ribeiro Replybullet Topic: Waiting for diagnosis
    Posted: 26 Oct 2009 at 7:13pm
Dear all, first of all, my apologies for my bad English, specially for medical terms.
 
My name is Rodrigo, I am from Brazil, 37 years old, male. Three months ago, due a sudden pain in my stomach“s upper part, my doctor asked an endoscopy, and biopsy“s result was " complete colunar intestinal and stomach metaplasia with no malignity", besides hiatus hernia, reflux... two doctors said that it“s not Barrett, but my last (and more expert) doctor said "yes, this seems to be Barrett“s. Oes." In order to confirm this diagnosis, he prescripted another endoscopy with image magnification, which will take place on Nov 3rd. Unnecessary to say how anxious I am about the results...
 
My doctor said that, once confirmed the diagnosis, the hiatus hernia surgery would be the best option, in oder to stop acid“s agression, and stabilize the Barrett. After that, drugs like Lansoprazol in order to reduce stomachal acid, and annual endoscopies to check the status of the metaplasic area.
 
My questions:
is every kind of intestinal metaplasia on Oesophagus considered Barrett“s Oesophagus?
Since I had no symptoms until three months ago, is that possible that B.O. can occur that fast?
Is the surgery + PPIs the best options/warranty in order to make sure that metaplasic area don“t turn into oesophagus cancer?
What“s the average years to a B.O. to turn into cancer, without treatment?
Is that possible that Barrett“s turn into cancer despite of the interruption of agression?
Finally, is that possible a normal life despite of Barret“s Oesophagus, after treatment? (normal life meaning one slice of pizza, one pint of beer or a glass of wine once in a while, etc)?
 
Best regards, and thanks in advance
Rodrigo Ribeiro  


Edited by Rodrigo Ribeiro - 26 Oct 2009 at 7:17pm
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Muxey
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Quote Muxey Replybullet Posted: 27 Oct 2009 at 3:47pm
Hope this helps on a couple of your questions.
I han no symptoms of acid ie heart burn etc. The first I knew was a cough that was persistant,  Finaly an endoscopy found barretts !!
The lanzoparazol is working wonders allmost no side effects on them around 1 year now
Eat and drink anything in moderation. SO a normal life is possible !
The sooner you understand more about it it dose not seem so worrying.
Best wishes. Harvey.

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Quote Rodrigo Ribeiro Replybullet Posted: 29 Oct 2009 at 1:53pm
Dear Harvey, thanks for your explanations...since I“ve been told with Barret“s I spend my day researching and thinking about this issue. My doctor said that I must not spend the day reading and thinking about this, and being anxious and nervous is not good, that I must relax, since the more worried, the more acid my stomach will produce. Besides, he said people are different, so what works for one person doesn“t work for another. But I am a little confused, since I was pretty sure whether any type of intestinal metaplasia (bowel tissue on oesophagus) means Barrett“s, or just a specific type of metaplasia means Barretts.
 
 Other doubts, if the dear friends could help me to clarify:
 
let me see if I understand the sequence: reflux, oesophagitis, metaplasia(Barrett“s), low level dysplasia, mid level dysplasia, high level dysplasia, neoplasia (cancer). In average, how many years from one step to another? Is there efficient treatments for each step of this disease?
 
After Barrett“s is there, is the goal of MD“s to stop acid (like hiatus hernia“s surgery)then stopping Barrett“s to develop? Is that possible that someone with Barretts never develops any dysplasia or cancer for life?
 
Please reply to my questions. If possible to Mr. Chris Rob to reply too, I would be more than grateful.
 
Best wishes to everyone, Rodrigo (Brazilain guy)


Edited by Rodrigo Ribeiro - 29 Oct 2009 at 1:53pm
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chrisrob
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Quote chrisrob Replybullet Posted: 30 Oct 2009 at 9:58am
Hi Rodrigo and welcome,

Firstly I am not a doctor so am not qualified to answer your questions definitively. I can, however, talk from personal experience and from my own research on the internet.

I do not know anything about the Brazilian health arrangements: procedures indicated below are what is routinely possible with our UK National Health Service.

It does seem that the early stages of change to Barrett's and dysplasia arer generally slow which is why in the UK it is usual to only have endoscopy every three years if Barrett's is detected without dysplasia.

Your analysis of the possible progression sounds typical.
Barrett's is squamous metaplasia of the oesophageal epythelium probably as a defence against acid corrosion.
The oesophagus isn't protected against acid in the same way the stomach and intestines are. That is why, when we get reflux of acid into it, we get the burning sensation we call heartburn which can cause oesophagitis - infalmmation of the gullett.

I was first diagnosed with oesophagitis in 1994 when I had my first endoscopy after years of extreme heartburn occasioned by considerable stress at work.
I was conscious throughout, having had the throat spray, and the surgeon showed me what he was doing on a display screen and talked me through it. He showed me the red raw area of oesophagitis and my hiatus hernia and the red area he said was like the lining of the intestines which he didn't want to see there. However he didn't biopsy the cells and I wasn't diagnosed with Barrett's.
Following another endoscopy a few years later, I was offered the Nissen Fundoplication. he explained he didn't like keeping patients on acid suppressant drugs for too long as they can mask the appearance of cancer.
I met someone who had had the operation and it sounded horrendous. In the days it would have been a full open procedure with many attached risks. My doctor decided we'd continue trying to control it with lansoprazole or omeprazole.

It was when the drugs started losing their effectiveness I started researching for myself and found out about Barrett's. (I was only rarely getting the raging heartburn or bile reflux at 3:00 am but my cough had increased and I had been put on the highest possible dose of omeprazole.) The pictures I found of the condition looked, to my untrained eye, like the images I had seen on the screen during that first endoscopy.Thus it was no surprise to me when I had the diagnosis of Barrett's confirmed just three years ago.

The usual treatment is to reduce the acid using a proton pump inhibitor. This deprives the Barrett's of the environment that could lead to its progression. It also helps the lower oesophageal sphincter. Acid can cause its muscles to relax facilitating reflux. However, PPI's themselves do not stop the reflux, just the acid.

To stop reflux, the usual way is with the Nissen Fundoplication operation which is usually carried out nowadays laparoscopically.
I had the operation earlier this year as the maximum dosage of PPI was not stopping the cough and the reduced stomach acid was causing other problems ("hypochlorhydria" - the worst effect of which for me being the anaemia from lack of iron absorption causing me extreme lethargy).

That operation gave me my life back (though I still have Barrett's, I don't take any medication) but it's not to be recommended for everyone as all operations carry their own risks. If the drugs work for you, that's fine.

If in regular endoscopic surveillance, the specialist sees low grade dysplasia, the frequency of surveillance may be increased. If high grade dysplasia is diagnosed, treatment may be offered. The latest is radio frequency ablation using the HALO generator. This is performed endoscopically with a high energy beam burning away the Barrett's tissue.

HALO treatment looks like it can cure Barrett's but, as with all surgical techniques, there are risks involved so it is usually only offered when it looks as if the Barrett's has the potential to become cancerous.

But the majority of people with Barrett's will never develop adenocarcinoma.
For me, apart from filling up pages on this forum and helping with a local support group, I can ignore my Barrett's (unless some future endoscopy tells me otherwise).

All the best. (You may read more of my story on my website: www.chrisrob.co.uk )

Chris
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Rodrigo Ribeiro
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Quote Rodrigo Ribeiro Replybullet Posted: 30 Oct 2009 at 12:40pm
Hi Chris
 
First of all, thank you for your explanations and kindness on answers.
 
The strange thing is that, as far as I know, despite of the huge quantity of people with Baretts, the forum has only around 300 members, and Orkut only one comunity with only 80 members...is that disease so rare? 
 
Regarding health care in Brazil, there are two options: the public system, that, despite of the high quality of the doctors and nurses, given the high demand, takes too much time to a citizen obtain a consult. The other option is the private system, that is my case, when you can schedule a consult with a specialist within 3 to10 days, depending on the doctor“s agenda. Sao Paulo has several excellent hospitals who are reference in Latin America (Albert Einstein, Sirio Libanes, Instituto do Coraēćo, Hospital das Clinicas, among others).
 
Two months ago, until 20 days before, my symptoms were very bad, I could not eat anything, I had nauseas all the time, stomach ache, due the medication (02 Nexium 40mg a day + 02 digeplus after "meals"). That caused a duodenal inflamation due the extreme lack of acidity in stomach. The gastro-endoscopist who scoped me in emergency saved my life 20 days ago, changing my treatment to Lansoprazol 30 mg a day. Since then, I am ok, feeding normally, with no pain anymore, and my intestine is working normally again.
 
Regarding my symptoms, I do not feel acidity or heartburn. The only thing I feel/hear is like a squeaking or fizzle in my throat in the morning, when I am still lying in bed. That is not an eructation, it sounds like gas reaching my throat. My diet is now based on rice, beans, fruits, smashed potatoes, small portions of milk with a bit of coffee, bovine beef, chicken, some pasta and bread, and vegetables. I have eliminated pork, alcohol, pure coffee, yellow cheese, fat, garlic, oily, spicy food, etc.
 
The best thing is that now I am happier and more alleviated, being aware that I am not alone, that several people have the same condition than me, that Barretts is a condition, not a disease, that it“s very possible to live with, and that it“s possible to carry a normal life, keeping the surveillance, but keeping alive and with good quality of life!!!
 
Thanks again for your precious support.
 
Best regards,
 
Rodrigo 
 
 
 
 


Edited by Rodrigo Ribeiro - 30 Oct 2009 at 12:41pm
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Quote Rodrigo Ribeiro Replybullet Posted: 05 Nov 2009 at 12:36pm
Hello Chris
 
Yesterday I have done me endoscopy with image magnification, and, in spite of the biopsies are not ready yet, thanks to God, the endoscopist (who is one of the best Brazilian endoscopists) has told me that my Barrett“s segment is milimetric, too small, without dysplasia and I have no reason to concern about it, just making EGD“s every year. He even did not encouraged me to do the fundo surgery because of Barretts, unless my symptoms of reflux are too severe. I know that it“s a really good news, hence I want to share with you guys, since I was really worried about the EGD“s results.
 
Now I will consult my gastro on Nov 12, when I will describe my symptoms:
lack of appetite (I have lost 12 Kg in three months), a strange sensation on my throat, that sometimes leads me to nauseas, eructation even after drinking a glass of water.
 
Regarding the appetite and losing weight, I think it“s normal, they might be associated to my concern these last days until my EGD and good news from doctor.
 
Does anyone else have these symptoms? Are they classical symptoms of reflux? Is it normal, even after taking Lansoprazol 30mg daily and quitting eating any fat, oily, fried, alcohol for more than two months?
 
Please let me know.
 
Best wishes
 
Rodrigo
 


Edited by Rodrigo Ribeiro - 05 Nov 2009 at 12:50pm
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jcombs99
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Quote jcombs99 Replybullet Posted: 06 Nov 2009 at 12:45am
Rod
   Yep , I like your doctor .Just make sure you do what your doctor told you to do and your EGD is 12 months to the date with biopsies .I had mine on Monday and " IT'S LOOKIN GOOD SO FAR " .

    HGD JEFF
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Rodrigo Ribeiro
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Quote Rodrigo Ribeiro Replybullet Posted: 06 Nov 2009 at 11:20am

Hello Jeff, what a good news!!! Congratulations!

I am happy that you are doing very well and your EGD shows that everything is alright.
 
My best wishes
 
Rodrigo
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