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Ppis and Barretts

Printed From: Barrett's Support Forum
Category: Barrett's Support Forum
Forum Name: General
Forum Discription: A place to just chat & introduce yourself
URL: http://www.barrettscampaign.org.uk/forum//forum_posts.asp?TID=2032
Printed Date: 13†Dec†2019 at 11:43am


Topic: Ppis and Barretts
Posted By: Sm12
Subject: Ppis and Barretts
Date Posted: 06†Apr†2019 at 11:17am
Hi new member here had an endoscopy last year which showed grade 1 esophagitis and Barretts wasnít mentioned, can they tell if Barretts is present or not if thereís inflammation by the les?
Could it be possible to be under inflammation and do ppis actually stop Barretts and stricture if used long term? Ppis heal esophagitis apparently but do they stop Barretts happening. I ask as Iím in process of deciding if I am going to have the surgery, Thanks



Replies:
Posted By: chrisrob
Date Posted: 07†Apr†2019 at 12:16pm
Hi and welcome.

According to the Savary-Miller scale, grade 1 oesophagitis shows "single or multiple erosions on a single fold. Erosions may ooze fluids or just show redness." (There are 5 grades https://sites.google.com/site/downwithacid2/home/complications/oesophagitis - as defined here .)

Barrett's cells are usually visually discernable as slamon coloured patches, particularly at the 3 o'clock position, near the junction between the stomach and the oesophagus.
It is within those suspect areas biopsies would be taken; Barrett's can only be definitively diagnosed by a histopathologist examining biopsied cell samples.

Inflammation at the lower end of the oesophagus can make it difficult to identify Barrett's, particularly if there is bleeding.

PPIs will reduce acid, though not reflux: they just make it less damaging. With reduced acid, the oesophagitis will be permitted to heal. Barrett's cells are produced by the body as an "armour plating" to protect against acid erosion. Strictures may be the body attempting to reduce reflux.
There are many factors to the development of Barrett's which we are gradually discovering. The most obvious requirement is acid + bile + reflux ( https://sites.google.com/site/downwithacid2/home/complications/barrett-s-oesophagus/put-simply - as described here ) but genetic factors also play a part as well as age, sex, body build etc.

What surgery are you contemplating? I'm guessing a https://sites.google.com/site/downwithacid2/home/reflux/reflux-reduction/fundoplication - fundoplication ? I had that 11 years ago - for me it was the best thing I ever did.

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


Posted By: Sm12
Date Posted: 07†Apr†2019 at 12:59pm
Thanks for reply, I think you are right with the genetic factor my father and nan had same problems. Yes Iím thinking about the Nissen Fundoplication think thereís no other options really tried all ppis for years help a little with heartburn but not extra oesophageal symptoms . The change in anatomy and lack of vomiting scares me tho, and losing too much weight after. Also duration of it lasting as Iím 43.


Posted By: chrisrob
Date Posted: 07†Apr†2019 at 5:06pm
I was first offered fundoplication in 1994. Then, although keyhole surgery had been introduced for it, it would have been open surgery and I was too scared.
When I eventually had in in 2008, I was desperate enough to have tried anything. But it was a breeze. Forget the scaremongering about not being able to burp or vomit - most people can, though some need the scar tissue to heal first. I actually burped OK before I left hospital.
You may read my story and a number of others' on the https://sites.google.com/site/barrettswessex/home/patient-experiences#TOC-Fundoplication - Barrett's Wessex website, here .

And, losing weight? I lost 20 lbs - which is about the same as many others have reported.

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


Posted By: Sm12
Date Posted: 08†Apr†2019 at 1:45pm
Thanks chrisrob think Iíll have to give it a go maybe try put half stone on before having it done. Another question I have is recently an ent done a laryngoscopy to check vocal chords and he said they were fine no redness, moving fine but any idea why I still struggle I intermittently with voice he mentioned voice therapy but seems like Iím just wasting money all time seeing these different specialists looking for answers. Can the lpr symptoms affect voice but show no redness or inflammation?


Posted By: chrisrob
Date Posted: 09†Apr†2019 at 11:43am
Certainly https://sites.google.com/site/downwithacid2/home/reflux/lpr - LPR (Extra-Oesophageal Reflux) can affect the voice box. As it attacks from the "underside", I guess redness is not visible as if it were from infection from above?

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


Posted By: Sm12
Date Posted: 12†Apr†2019 at 11:08am
Thanks my other main symptom is my breathing hasnít been great all the time lately, sometimes heavy seem to notice it more after eating not sure if thatís a psychological thing but did you have any problems like that before your op and weíre they fixed along with the hoarseness?


Posted By: chrisrob
Date Posted: 12†Apr†2019 at 11:56am
Extra-oesophageal reflux can certainly affect the lungs, as described https://sites.google.com/site/downwithacid2/home/complications/ent - in this chapter of Down With Acid .

I was tested (negatively) for asthma. A number of refluxers are told they have asthma (though they mainly don't). Our http://www.barrettsessex.org.uk - Barrett's Essex co-ordinator has serious lung / breathing issues and damage caused by micro-aspiration of refluxate.

Even after my op, my wife tells me sometimes, after eating, I'm wheezing.
A year ago, I had lung function tests at the hospital. I had a spell where I was tired constantly and concerned it could be due to lung damage. I was told my lung function was 110% of what would be expected of a person of my age. The pulmonologist said he'd be surprised if there wasn't some damage from a lifetime of reflux but it wasn't affecting my breathing.

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


Posted By: Sm12
Date Posted: 12†Apr†2019 at 12:04pm
Thanks chris, how long do fundoplications usually last? Or is that a how longs a piece of string question


Posted By: chrisrob
Date Posted: 12†Apr†2019 at 12:21pm
Longevity of fundoplication nowadays is usually quite good if performed by a good surgeon - but you usually get who you get with NHS.

My first fundo ( https://sites.google.com/site/robichris/barretts#TOC-The-Laparoscopic-Nissen-Fundoplication-operation-16-March-2009- - described here ) was actually performed by a newly qualified surgeon though it lasted well for 5 years but came loose following 5 hours violent retching due to norovirus. I knew it probably wouldn't survive the internal gymnastics that was going on.
My revision 5 years ago used a more permanent Collis-Nissen procedure whereby the oesophagus is first effectively lengthened by resectioning of the stomach to provide a larger space for a better wrap. It was performed by a good surgeon at Southampton and, at my last scope, a year ago, I was told it was still intact - as I'd expect.

A paper published in 2015,
https://www.ncbi.nlm.nih.gov/pubmed/25487547 - 20 years later: laparoscopic fundoplication durability , found, "Long-term results from the early experience with LF are excellent with 94% of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18% required surgical revision surgery to maintain their results."

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


Posted By: Sm12
Date Posted: 12†Apr†2019 at 12:35pm
I see thereís quite a high percentage of people back on ppis tho, probably with better symptom control


Posted By: chrisrob
Date Posted: 12†Apr†2019 at 1:10pm
I had been on 80mg omeprazole daily prior to my first fundo, with no benefit to my reflux - though no more heartburn. (But I knew it if I missed a day.)

Following the op. I was totally off meds until the wrap failed.
Following second op, totally off meds again until just over a year ago. I'd started getting a small amount of oesophagitis again (though only noticed it if I had my customary glass of wine with my dinner). That's when I went for a requested scope to confirm and went back on 20mg omeprazole, which is when it was confirmed my wrap was intact. Another scope a few weeks later showed inflammation had healed and I can drink wine again with no problem. But I'm staying on low dose omeprazole just as a precaution. No reflux issues and if I miss a day, I don't notice it.

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


Posted By: Sm12
Date Posted: 12†Apr†2019 at 1:21pm
Thanks Chris just read your book downwithacid very informative.


Posted By: Sm12
Date Posted: 14†Apr†2019 at 2:54pm
Hi Chris you say you were in 80mg ppis before op that didnít work apart from getting no heartburn, what symptoms of reflux were you getting then to finally go for op? Thanks


Posted By: chrisrob
Date Posted: 14†Apr†2019 at 6:05pm
The omeprazole was great at reducing the acid and curing my oesophagitis, but it did nothing to reduce the reflux.
(A https://www.academia.edu/33849157/Prevalence_of_Extra-Oesophageal_Reflux_symptoms_amongst_acid_refluxers_and_perceived_efficacy_of_regular_medication_and_reflux_reduction_intervention - survey I conducted a couple of years ago led to the conclusion, "In the management of symptoms of extra-oesophageal reflux, acid suppressant medication did not appear to be effective whereas reflux reduction surgery was.")

I had reflux symptoms all my life but didn't realise they were reflux.
My worst symptom prior to my op was my chronic reflux cough. I'd have a coughing fit at least once a day which would last 2 hours and end with me practically passing out.

https://sites.google.com/site/downwithacid2/home/appendices#TOC-Symptom-checker - This symptom checker lists most of the symptoms that may be due to acid or reflux.

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


Posted By: Sm12
Date Posted: 18†Apr†2019 at 4:31pm
Any problems with nasal congestion/sinusitis before your fundoplication that was sorted with the op? Always constantly blocked


Posted By: chrisrob
Date Posted: 18†Apr†2019 at 6:05pm
Constant problems with blocked nose and sinusitis.
I remember my mother taking me to the doctor when I was three years old. She was concerned I was a "mouth breather". Doctor said it was "childhood catarrh" I'd grow out of!
A couple of years later, I had my tonsils and adenoids out to see if it helped.

In my late twenties, I used to suffer terribly with sinusitis and had my sinuses flushed on a few occasions.
I've had allergy tests. An ENT surgeon declared I had nasal polyps but another said he couldn't see any.

I just got used to living like that. Once I'd had my fundo, I could breathe again and discovered I did have a sense of smell after all.

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


Posted By: Sm12
Date Posted: 29†Apr†2019 at 8:59pm
Hi Chris I saw a surgeon today gonna have another endoscopy as itís been 18 months then probably go ahead with the surgery, one thing that concerns me that he mentioned was vagus nerve damage is possible canít remember the percent he said. Any idea and how dangerous is it? Thanks


Posted By: chrisrob
Date Posted: 30†Apr†2019 at 12:58pm
There is a small risk of damage to the vagus nerve form fundoplication since it runs adjacent to the eosophagus.

This paper, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356483/ - Gastric Emptying and Vagus Nerve Function After Laparoscopic Partial Fundoplication , from 2004, concluded, "Laparoscopic hemifundoplication affects vagus nerve integrity in 10% of patients, but this does not lead to a delay in gastric emptying. In fact, gastric emptying improved significantly after fundoplication."

Damage to the vagus nerve can result in https://sites.google.com/site/downwithacid2/home/other/dumping - "Dumping Syndrome" where the stomach empties (dumps) too quickly into the duodenum.
This is actually very rare with an ordinary fundo (with a rare case reported here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015671/ - Dumping Syndrome as a Complication of Laparoscopic Nissen Fundoplication in an Adult ) but more likely with more extensive surgery like an oesophagectomy.

Following my Collis Nissen revision, I have experienced dumping syndrome to the extend of rapid faint on three occasions. Although I rarely get it now, I recognise the early symptoms when I start feeling vague and losing concentration, possibly feeling nauseous. I always keep dextrose tablets or Kendal mintcake to hand and a bottle of water. I find two or three dextrose tablets or a bar of Kendal mintcake and drinking lots of water helps prevent further progression.
Because two of my fainting occasions, occurred in the bathroom, my wife makes sure there's a bottle of water and dextrose tablets readily on hand there.

I did seek help from my surgeon who wanted to rule out any possible heart problems causing the attacks and had me fitted with a https://www.medtronic.com/uk-en/patients/treatments-therapies/fainting-heart-monitor/reveal-linq-icm.html - Reveal Linq heart monitor but I've not had a fainting attack in the 4 years I've had it.

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


Posted By: Sm12
Date Posted: 23†Jul†2019 at 6:09am
Hi Chris just an update I met the surgeon 2 months ago and he wanted another endoscopy done, I had one a year and a half ago done and esophagitis grade 1 was found so I was quite surprised this time that grade 2 was found with mild non erosive gastritis even tho for the most part apart from the 2 week lead up to endoscopy Iíve been on 2x lansrapazole daily, sometimes 1. Any idea how this could happen and is there any treatment for the gastritis? Iíve got a follow up soon, thanks



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