Barrett's Oesophagus
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chrisrob
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Quote chrisrob Replybullet Posted: 16 May 2011 at 4:29pm
An inflamed oesophagus (oesophagitis) is not the same thing as Barrett's Oesophagus (intestinal metaplasia) which is more like scar tissue.
Anyway, it's another question you can ask Rebecca Fitzgerald next week?
Chris
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johnd
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Quote johnd Replybullet Posted: 16 May 2011 at 6:46pm
Me again.
The thing I feel when I read this thread is - how do you know what the 'right' dose of PPI's is for you? The OP wants to reduce her PPI's, Richard has written widely on his experiences, and I am tinkering with moving down to 20 from 30.

But if the E can, for many people, be slightly desensitised against heartburn because of the Barretts lining, how do you know you are suppressing acid enough to halt progression? I don't think anyone knows the answer, but it might a question (amongst I am sure amongst a million others) for your expert at the coming meeting.
55yo, diagnosed 2011 at 5cm Barrett's, 3cm as at 2013 (?), so far non-D
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jcombs99
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Quote jcombs99 Replybullet Posted: 16 May 2011 at 6:57pm
j
PH Test(had 5) and your doctors opinion.. It's good to take less drugs IF they still do the job..No Doctors here ..

Edited by jcombs99 - 16 May 2011 at 7:31pm
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Carolyn
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Quote Carolyn Replybullet Posted: 16 May 2011 at 11:28pm
Hi to all you knowledgeable people and thanks for all the feedback. I think I will stick with chris's suggestion of a small red wine with dinner, certainly tastes better than vinegar. But you have all improved my knowledge of Barretts.
My specialist actually recommended I try to cut back on meds as I wasn't sleeping, coughing, flatulence, and according to my husband, a bit depressed. I need to control that one! Anyway over a fortnight I phased out the ranitidine, and just had 15mg PPI morning and night.
And last night I woke about 2am with an awful dose of heartburn and today feel a bit battered in the chest and my E is very sensitive, so it's back to some ranitidine at night.
Jeff, I have followed Liz's progress and feel for her, and just hope my LG doesn't get to that stage!
Chris, thanks for the info re a surgeon who ablates in NZ, and will keep a note of his name meantime. Waikato is up north,one of our larger cities, about 600km from here where I am, at the top of the South Island,
where our population is only 4000, but distance is not a problem really. My spec. said don't let anyone tell you that ablation is not a big deal, because it is - however, will wait and see if things change.
Anyway, thanks again for all the feedback, this forum is great, you guys seem to know more than the GPs.
Keep up the info flow please.
Meanwhile, enjoy your summer, we are going into winter over here. I have enjoyed 2 really hot summers in England while holidaying over there in your lovely country, and hope to get back (all going well) in the next couple of years.   Cheers.....Carolyn
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RichardT
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Quote RichardT Replybullet Posted: 17 May 2011 at 8:20am
> An inflamed oesophagus (oesophagitis) is not the same thing as Barrett's
> Oesophagus (intestinal metaplasia) which is more like scar tissue.
> Anyway, it's another question you can ask Rebecca Fitzgerald next week?

Indeed it is not.

However in the early stages, Barrett's is itself inflamed. Only when acid and bile are controlled is the inflammation likely to go. At least, that's what I suspect.

I also intend to ask exactly how corrosive bile is! Bile reflux seems to be much ignored.

www sites and contact:
www.Torrens.org.uk/Med/
www.GreenBottom.org

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RichardT
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Quote RichardT Replybullet Posted: 17 May 2011 at 8:31am
> And last night I woke about 2am with an awful dose of heartburn and
> today feel a bit battered in the chest and my E is very sensitive, so
> it's back to some ranitidine at night.

There are some very long delays involved in Omeprazole!
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2036.2000.00788.x/full
gives much detail on the way they work and the way they are eliminated. There are several different 'half-life' effects.

This paper explains why initial high doses are prescribed and why, logically. onedose/day should work. However I can also understand from it how my trickle-charge of frequent small doses works.

What is not clear is why rebound acidity occurs between the large daily dose and the trickle-charge system. And why the large dose triggers bile reflux.

I would say that if you decide to do for say 30mg per day - do it as 3 small doses rather than a single dose!

Yes, I'm formulating lots of questions for Friday!
www sites and contact:
www.Torrens.org.uk/Med/
www.GreenBottom.org

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RichardT
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Quote RichardT Replybullet Posted: 17 May 2011 at 9:34am
> But if the E can, for many people, be slightly desensitised against
> heartburn because of the Barretts lining, how do you know you are
> suppressing acid enough to halt progression? I don't think anyone knows
> the answer, but it might a question (amongst I am sure amongst a million
> others) for your expert at the coming meeting.

A coupe of years ago, Dr Fitzgerald was interviewed on the Today program, radio 4. One of the things she said was that they do not know how significant is the supression of symptoms.

From my own experience, I am lucky in that I taste refluxate sufficienty often to monitor its state.

Yes, there is a problem here if you aren't aware of the refluxate. I guess a swallowable radio pH meter would be useful, but hardly a DIY thing!
www sites and contact:
www.Torrens.org.uk/Med/
www.GreenBottom.org

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chrisrob
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Quote chrisrob Replybullet Posted: 17 May 2011 at 11:45am
I realise people may be misinterpreting what I said about desensitisation at the risk of totally missing the important point.
Barrett's cells are not as sensitive to pain as squamous tissue. The real problem is, as John points out, that once you have Barrett's you may not feel the acid refluxing.
It is estimated that only 10% of those in the population with Barrett's are known to doctors - and they don't know themselves.
It is possible their Barrett's was formed 20 years ago when they used to suffer heartburn which seemed to cure itself. (It didn't: they just don't feel it any more.) These are the people at risk of adenocarcinoma who won't know it until it's too late.
How do we get that message across?
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Terrapin54
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Quote Terrapin54 Replybullet Posted: 17 May 2011 at 12:32pm
 >Barrett's cells are not as sensitive to pain as squamous tissue. The real problem is, as John points out, that once you have Barrett's you may not feel the acid refluxing.
.
It is possible their Barrett's was formed 20 years ago when they used to suffer heartburn which seemed to cure itself. (It didn't: they just don't feel it any more.)<
 
Chris, I think you are absolutely right. From my teenage years until about 4 or 5 years ago, I useed to suffer regular heartburn and frequently resorted to Rennie's etc. I stopped getting heartburn, so no ant-acid tablets anymore. I did however develop a spasmodic cough, quite severe at times and sometimes resulting in vomiting. I put this down to another of my excesses, smoking. I had no idea it was acid reflux until I went for an endoscopy on an unrelated matter (or so I thought) and had an endoscopy which discovered the Barrett's, which I had never heard of. Since I have been on omeprazole alot of the acid reflux problems have subsided and I find it suits me very  well.
 
On your question about raising awareness, any chance of Rennie's, Gaviscon et al to subsidise research from some of their no doubt highly profitable products?LOL
 
Regards
Richard 
Whereof of one cannot speak, one must remain silent.
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chrisrob
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Quote chrisrob Replybullet Posted: 17 May 2011 at 12:42pm
Hi Richard,

We are having talks with Reckitt Benkiser (who manufacture Gaviscon). We're hopeful something will come of it.

Chris
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