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Barrett's, Hiatus Hernia and Gallbladder

Printed From: Barrett's Support Forum
Category: Barrett's Support Forum
Forum Name: Barrett's Oesophagus
Forum Discription: Your Questions about Barrett's Oesophagus
URL: http://www.barrettscampaign.org.uk/forum//forum_posts.asp?TID=1339
Printed Date: 09 Dec 2019 at 10:32pm


Topic: Barrett's, Hiatus Hernia and Gallbladder
Posted By: jkingdon
Subject: Barrett's, Hiatus Hernia and Gallbladder
Date Posted: 12 Apr 2014 at 2:12pm
Hi, I am new to Barrett's Wessex and to this Forum but I have a question. I have gallstones and will probably have to have my gallbladder removed. Does anyone know whether this could make my Barrett's worse due to the possibility of more bile reflux following removal of my gallbladder? Any thoughts gratefully received. John



Replies:
Posted By: teacher man
Date Posted: 12 Apr 2014 at 3:17pm
Hi john, welcome. What are your symptoms.?
I have read some people do a flush and prevent their gallbladders from being removed. Could be hog wash though.
I did find this helpful and read some people helped their gallbladder with carrot juice.
Try this if you want. Go to a place where they juice. Ask them to make you a carrot juice. Then take that carrot juice base and put it in to a smoothie machine and have them add carrots. It's the carrot fiber that will flush your system. I didn't have mine super fiberous but it was smoothie like. Try this for a few days. Also, eat lots of carrots. But carrot smoothies all the way. With a try.


Posted By: Pyrrhonist
Date Posted: 12 Apr 2014 at 5:08pm
> I am new to Barrett's Wessex and to this Forum but I have a question.
> I have gallstones and will probably have to have my gallbladder
> removed. Does anyone know whether this could make my Barrett's worse
> due to the possibility of more bile reflux following removal of my
> gallbladder? Any thoughts gratefully received.

Did you have gall stones before you started taking PPIs?
http://www.springerlink.com/content/2238h2k756607401/
http://www.springerlink.com/content/p4qt7lx3j53g2813/
These papers seem to indicate that PPIs very commonly interfere with proper gall bladder operation. I have heard of four people who all believed that their gall bladder problems were due to long term PPI use.

I know noything about gall stones, except that they are said to be mainly cholesterol crystals. Cholesterol is excreted by the liver as a standard function of digestion.

Chemically - crystals will form if the concentration is too high. The gall bladder does concentrate bile but should release it in the normal course of digestion. If the gall bladder is prevented from operating normally, bile concentration can only increase.

It's a theory to discuss with your doctors and may give you some thought for further research. Google scholar is a search engine for technical papers and can be very useful - though a lot of the medical papers are far too technical for all of us who have no medical training. But there are some authors who do their best to avoid techical jargon.

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: Sandra W
Date Posted: 13 Apr 2014 at 12:23pm
Hi all,
 
Please don't mess about if you have gall bladder problems, especially stones.  If you have symptoms, you need to take this seriously and make sure you get a referral to get this sorted as soon as possible.
 
My mother suffered years of chronic sickness and agonising abdominal, chest and shoulder pain.  Although her GP knew she had gallstones, he did not refer her to a specialist but just kept telling her not to worry.  Finally, in early 1997, she saw another doctor and got sent to see a surgeon.  He arranged tests and a follow-up appointment to attend the clinic on 14 August 1997 to get the results.
 
Unfortunately, he never got the chance to try and sort this out.  Mum was taken very ill and subsequently died 24 hours later on 7 August, exactly a week before her clinic appointment.  The post mortem report states the cause of death as septicaemia caused by empyema (pus in body cavity) of gall bladder, which had developed from complications of inflammation and infection arising from the untreated stones.
 
If you have a gall bladder problem, just make sure you get help, fight your corner and DON'T let them fob you off!!!
 
All the best,
 
Sandra.
 
All the best,


-------------
E-mail: swilliams888@hotmail.co.uk


Posted By: jkingdon
Date Posted: 26 Apr 2014 at 4:42pm
Thanks for the replies. Specifically, I was seeking views as to whether by removing the gallbladder there might be more bile refluxed into the stomach resulting in damage to the oesophagus in a person who also had a hiatus hernia. The doctor that I have consulted was not sure. Any further views would be much appreciated. Thanks.


Posted By: Pyrrhonist
Date Posted: 27 Apr 2014 at 1:10pm
link - it is very tenuous and not at all common.

But I think if you already have a tendency to form large stones, PPIs cannot help.

> Specifically, I was seeking views as to whether by removing the
> gallbladder there might be more bile refluxed into the stomach
> resulting in damage to the oesophagus in a person who also had a
> hiatus hernia.

Nobody here will be sure either. However the gallbladder's function is to hold and concentrate bile. Concentrating bile is how stones form. Probably most people only small crystals form which are easily removed with normal gall-bladder function.

With no gall bladder, any bile produced has to be passed very quickly into the duodenum. Whether this makes bile reflux more or less likely I cannot guess. My own experience is that, as PPI dose wears off, he gall bladder expresses bile erratically - even spasmodically. Expressing bile at the wrong time can lead to bile reflux. It seems possible that a more even flow (because of cholesysectomy) could cause less reflux.

To learn more about the liver etc, see
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/index.html
or search for the Sphincter of Oddi.

Good luck.

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: bouncethruit
Date Posted: 02 May 2014 at 4:03pm
Hi jkingdon

I sincerely hope you are not suffering with your gallstone issue anymore and that it has been effectively resolved.

In answer to your query and speaking from my own experience (NB: Always please bare in mind that everyone is different) I had my gallbladder removed together with the offending large black gallstones the insides of which were composed of grey crystallised bile salts, (I still have them and keep them in my jewellery drawer just to hiss at now and again!)

My gallstones were absolutely intolerable and it had become impossible for me to lead a normal life, I had no choice but to have the wretched things removed. However, prior to this I stupidly attempted to "flush" them out(lol), believe me, you have to drink a heck of a lot of apple juice or white cider vinegar to break those things up and anyway, they have rugged sharp exteriors. I think I did accidentally pass one (before I ever knew I had gallstones) a number of years before and it felt like a rat was trying to gnaw its way out of my stomach, painful is not the word.

I didn't have a diagnosis of Barrett's at endoscopy prior to removal of gallbladder. After removal of gallbladder, I started suffering itchy/burning sensation inside oesophagus and one year later, when I was again scoped, I was diagnosed with 1cm Barrett's which unfortunately appears to be increasing.

Between a rock and a hard place on this one.

Cheers.
Gilly

-------------
GfromWalesUK


Posted By: bobgil
Date Posted: 20 May 2014 at 9:31pm
As some people will know, I had a private halo for removal of non-dysplasic barrett's. However, it was also found that my gallbladder simply didn't work, probably due to long term use of PPI's. I can control it with a strict, non-fat diet and only rarely get any pain. When I spoke to my consultant, (whom I trust), he was undecided over the benefits of taking it out, because it may make trhe reflux problem worse. At present,I dont suffer any reflux and was barrett's free, at the last scope. So in my case, is it better to not have the gallbladder removed.


Posted By: jkingdon
Date Posted: 20 May 2014 at 11:41pm
Hello bobgil,

Thanks for you message. I have a similar dilemma in that I have gallstones which occasionally cause me a problem but I am uncertain whether to have my gallbladder removed due to the possibility of bile reflux being made worse. It is interesting to note that your consultant was undecided about whether your reflux would be made worse by gallbladder removal. Like you I control my gallbladder by a very strict low fat diet. I have done some research on the pros and cons for people with Barrett's and Hiatus Hernia having their gallbladder removed. There are many papers that say bile reflux is made worse and a few that say it makes no difference. On the other hand holding onto a gallbladder with gallstones also comes with risks. I think this is a particular concern for those of us with Barratt's and I am finding it very difficult to find definitive advice. I am seeing my Gastroenterologist shortly to put the issue to him and thereafter may seek a second opinion. I would be most grateful to know the name of your consultant should in my case a second opinion be necessary - perhaps using a private reply if you feel that is appropriate. As always, any other comments from Forum Members also gratefully received. Thanks.


Posted By: Pyrrhonist
Date Posted: 21 May 2014 at 9:29am
I only have experience of bile reflux - caused by PPIs. The gall bladder's function is to store bile, concentrate it, and release it into the duodenum as food leaves the stomach. The release is via the Sphincter of Oddi - a Google will reveal lots of informative diagrams:
https://gi.jhsps.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=BB532D8A-43CB-416C-9FD2-A07AC6426961&GDL_Disease_ID=7AB086B0-AB01-446E-B011-2E67CAFEF96D
seems good.

Logically, if the gall bladder is not working as it should, it should be encouraged to work properly by eating foods and herbs that promote bile release.

Preventing bile release will concentrate the bile even more and the gall-bladder will then either release it spasmodically - or form gall stones.

I found that, as the PPI dose wore off, bile would be released but not times to coincide with food exiting the stomach. That caused bile to back-flow into my stomach, hence bile reflux. My consultants were unwilling (of unable) to discuss this!

But timing is the problem. Timing is controlled by a complex mix of hormones such as gastrin and cholesystokinin. PPIs certainly interfere with these hormones.



http://www.pfaf.org/user/Search_Use.aspx?glossary=Cholagogue
gives you a list of herbs and plants which are said to be Cholagogue - i.e. they promote bile flow. The list includes many edibles - e.g. Leek, garlic, olive oil, marjoram, cardoon. And many more which even I would not dare experiment with unless guided by a competent and qualified medical herbalist. Some doctors are so qualified,

It may give you more understanding and more information to discuss with your doctors!

Best of luck with your problems - keep us informed!


-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: MrJealousy
Date Posted: 21 May 2014 at 1:41pm
Hello all, I've only recently heard of bile reflux. Ive been on PPi for 22 years and they control my symptons really well, so I doubt if bile reflux is my problem. I had a scope this morning no barretts but 3cm Hiatus hernia.
I had my gallbladder out in 2004 after 6 years of pain and no diagnosis. 13 stones and a shriveled no functioning gallbladder.
The research I've done suggests that PPI use may cause gallstones and the mechanism behind this is reduced gallbladder motility and that when the gallbladder concentrates the bile, to stop the bile salts from precipitating out of solution the cells lining the the gall bladder secrete H+ ions using the H+ pump. PPIs could therefore be a mechanism behind the formation of my gallstones if I had the predisposition to favour H+ /K+ atpase expression over Na+ / H+

Ive recently come off PPIs because of side effects, one is arrhythmia which could be caused by a similar method. Apparently there are many other H+ pumps in the body including the kidneys and intestines. All of which could be effected by PPIs.
my advice would be if you have gallstones is have the bladder out. If you have chronic reflux have surgery, LINX probably the best as my fundopelcation lasted less than 2 years and I had painfull sideffects that lasted 5 years. dont stay on PPIs unless there is no other option and then the most minimal dose.


Posted By: Pyrrhonist
Date Posted: 22 May 2014 at 9:00am
That's interesting. But please excuse my doubt. Searching for "gall bladder proton pump" shows nothing other than the Cahan paper (at least in the early hits). Can you point me to the source of your information?

According to Wikipedia, the main constituents of gall stones are cholesterol and bilirubin, with sometimes calcium carbonate and other minor ingredients. H+ ions would then have little effect on the two main ingredients. So the presence of Proton pumps in the gall bladder seems unlikely.

Nor have I found reference to proton pumps elsewhere than in the stomach. So I'm interested to expand my knowkedge.

I think if there were other pumps - the side effects of PPIs would be far more severe than they seem to be. Most of the listed side effects seem to be due to malasorbtion of minerals, or possibly cholestasis.

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: chrisrob
Date Posted: 22 May 2014 at 10:47am
Richard.

I haven't time to do my own searches at present.
Can you send me links to any research you have on bile reflux as a rebound from stopping PPIs and on PPIs causing cholestasis.

Cheers
Chris

-------------
http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: MrJealousy
Date Posted: 22 May 2014 at 10:50am
Heres the first http://www.innovationsincrm.com/cardiac-rhythm-management/2010/december/29-proton-pump-inhibitors-focal-arrhythmias.
can seem to find the others that metioned that pumps are found else where. When I refind it I'll post it.


Posted By: Pyrrhonist
Date Posted: 22 May 2014 at 11:57am
Interesting. I have searched for such links to see if H+/K+-ATPase is present elswhere than in the parietal cells of the stomach and had found nothing.

So there appears to be a link between PPI use and heart arrhythmias.

Thanks for this!

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: Pyrrhonist
Date Posted: 22 May 2014 at 12:10pm
Just found

http://www.pharmacorama.com/en/Sections/H-pump-HK-ATPase.php

The second page says that H+/K+-ATPase is present in colon and kidneys. It's quite an interesting read on the way acid secretion and PPIs works.

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: Pyrrhonist
Date Posted: 22 May 2014 at 12:24pm
> Can you send me links to any research you have on bile reflux as> a rebound from stopping PPIs and on PPIs causing cholestasis.

No I cannot! Wish I could.

When I was experimenting on dosage, first I would experience a tickly cough. Then I would taste bile in the refluxate, only later would it become acid. This was very consistent.

When I went to 5mG and again when I completely stopped PPIs, I experienced bouts of very severe bile relux. I found the Cahan paper when searching for explanations for these two findings.

Either my physiology is extremely odd (which I find exceedingly unlikely) or I'm normal. If so - such bile reflux could explain many otherwise inexplicable findings:
1: Why are PPIs ineffective long term for so many (exact numbers are hard to find)
2: Why is oesophageal cancer still on the increase - despite the universal use of the "wonder drug" PPIs? Again, exact figures are elusive!

I have now been off PPIs for over two years and my gut is normal again and my reflux symptoms very minimal: if I didn't know had a hernia I would not even notice the reflux most of the time! But I'm sensitised and can take regular antacids at the forst indicatons. I don't get through a lot - though I do take sodium bicarbonate at bed times. There is no mechanism in the stomach for neutralising acid, but once neutralised, acid production overnight seems low so I sleep well.

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: MrJealousy
Date Posted: 22 May 2014 at 3:49pm
Well you got me doubting what I said and it seems that I have got my Na+ and K + mixed up. The bile is acidified by the gallbladder but by na h atpase. Saying that whos to know that my gallbladder cells didnt express k+h+ atpase more than na+ h+atpase and thus the reason for my gallstones was the inhibition of the proton pumps by PPIs.
Anyway here are afew links to reasearch / info on pumps in other organs and bile acidification

http://www.pubfacts.com/detail/21753033/Western-blot-confirmation-of-the-H+/K+-ATPase-proton-pump-in-the-human-larynx-and-submandibular-gland
http://www.ncbi.nlm.nih.gov/pubmed/14603049
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806118/
http://www.pharmacorama.com/en/Sections/H-pump-HK-ATPase-1.php
http://books.google.co.uk/books?id=ZfJN6NS0ZY4C&pg=PA105&lpg=PA105&dq=ph+of+bile+in+gallbladder&source=bl&ots=VGaTtdcb1c&sig=WNdxVRq55f2GlDrurDpg6eSs1hg&hl=en&sa=X&ei=dtF9U4ygK8GV7AaHpYDoAw&ved=0CDAQ6AEwAjge






Posted By: MrJealousy
Date Posted: 28 May 2014 at 11:50am
Heres another... on reading this there could be a link between H+/K+ ATPASE inhibition and Na+/K+ atpase inhibition.Which could explain gallbladder acidification problems, that I described earlier.
http://www.innovationsincrm.com/cardiac-rhythm-management/2010/december/29-proton-pump-inhibitors-focal-arrhythmias


Posted By: Pyrrhonist
Date Posted: 28 May 2014 at 2:02pm
> H+/K+ ATPASE inhibition and Na+/K+ atpase inhibition

It's a long time since I did Chemistry A level - it may have been my best subject but it wasn't my favourite!

H+/K+ and Na+/K+ may sound very similar, but electrochemically they are wildly different. Sodium ions have a similar energy to potassium ions and exchanging one for the other is not much work.

H+ ions however are much more energetic and swapping a K+ to an H+ requires much more energy.

The sodium - potassium (Na - K) balance in the body is quite critical and certainly if the balance is wrong it can affect the heart. But I don't think it's relevant to PPIs!

I couldn't spot the reference to Na+/K+ atpase - except in the footnotes!

-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: Pyrrhonist
Date Posted: 29 May 2014 at 12:41pm
MrJealousy

I've been looking at the pages you gave. It seems that proton pumps are relatively common throughout the body. No reason why they should not be - once a cell has evolved, it can be used anywhere.

But in chemistry, you can't "pump a proton" without effectively pumping an electron to balance it. The electochemical difference between Na+ and K+ must go somewhere! There is a supply of bicarbonate ions (HCO3-) from the pancreas, used to neutralise the stomach acid. Bicarbonate ions are also present in the saliva and oesophageal mucosa.

So it looks like there are many places where these pumps exist in balance to maintain the correct pH.

The amazing thing about all this is that PPIs have so few side effects! If they kill Prpton pumps in the stomach, they must have the same effect on the other proton pumpps.

This is all quite interesting: my father was a surgeon who did a lot of colloidal microscopy work on blood and other fluids and he wrote a book on Dental Diseases - much of which was concerned with correct pH balance in the body. The book was never properly published - it had been printed and the printer's stock was bombed in the war, destroying the lot.

I have a copy and have been transcribing it!
www.torrens.org.uk/Books/DD/index.html


-------------
Richard Torrens. - See my www site for my own experiences with Barrett's and reflux etc.


Posted By: Yaya
Date Posted: 06 Jun 2019 at 12:11pm
Hi Bob
I m the mother of a 19 years old daughter who had been diagnosed with 1 cm of barrett no dysplasic and a small hernia hiatal!
We are living in USA and would like to eradicate the barrett! By any chance do you know a good surgeon to do it?
Thank you so much for your understanding and help.
Have a great day
Yaya


Posted By: Yaya
Date Posted: 06 Jun 2019 at 12:16pm
Originally posted by bobgil



As some people will know, I had a private halo for removal of non-dysplasic barrett's. However, it was also found that my gallbladder simply didn't work, probably due to long term use of PPI's. I can control it with a strict, non-fat diet and only rarely get any pain. When I spoke to my consultant, (whom I trust), he was undecided over the benefits of taking it out, because it may make trhe reflux problem worse. At present,I dont suffer any reflux and was barrett's free, at the last scope. So in my case, is it better to not have the gallbladder removed.



Newbie Plus


Joined: 25 May 2019
Location: United States
Online Status: Online
Posts: 3
Quote Yaya Replybullet Posted: Today at 12:11pm
Hi Bob
I m the mother of a 19 years old daughter who had been diagnosed with 1 cm of barrett no dysplasic and a small hernia hiatal!
We are living in USA and would like to eradicate the barrett! By any chance do you know a good surgeon to do it?
Thank you so much for your understanding and help.
Have a great day
Yaya



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