Any gastroenterologists out there?

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  • #600879

    oomis
    Participant

    If any of you is a gastroenterologist, what can you tell me about Barrett’s Esophagitis? Can any other more benign condition mimic its symptoms (or can someone be completely asymptomatic yet still be sick), and can it be mistakenly diagnosed? For how long a period of time can someone safely take Prilosec? Please don’t respond to ask my local doctor. We already have, but feel something is off in what we are being told. The internet research is not helping.

    #830789

    Hummingbird
    Participant

    Oomis1105, I don’t know anything about this illness. However, I just hope that who ever you are using as your doctor, I hope he’s really good in this field. Because if you get someone who is not very long in the business &/or not too experienced, I wish you luck!! You need to have someone who is extremely good at diagnosing various symptoms.

    I can give you the name of the Gastroenterologist whom I use. He’s uptown Manhattan. But these days, he’s only there part of the week since he’s semi-retired. But, he happens to be top of the line. His name is Dr. Present & he’s located at 12 East 86th st. bet. Madison & 5th Ave’s. His number is 1-212-861-2000. Call during the day till 3:30 P.M.-that’s when they stop answering calls. I just don’t know as to whether he takes new patients or not. So you’d need to find that out. Also, he doesn’t take any insurance. So you’d need to pay out of pocket & send the claim over to your insurance carrier if they accept out of network insurances.

    Hatzlacha Rabba whatever you decide to do & Refuah Sh’laimah!!

    #830790

    oomis
    Participant

    Thank you very much for the information, Hummingbird. We have good doctors, but something just sounded “off” in what we were told and I would like an opinion from a second or even third source, that would make sense to me.

    #830791

    A Heimishe Mom
    Participant

    I agree with Hummingbird to get another opinion. One can be on Prilosec or other anti-GERD medications for an extended period of time. I never heard of Barrett’s Esophagitis though so in direct relation to that I cannot answer. But I can tell you that Prilosec is an antacid type of medication and any condition that would require extended use of such medications would require frequent scoping of the esophagus (every 6mo or so) to check for cancer or other complications of the disease (not the drugs). If you are not comfortable with your current doctors please go find someone else!

    #830792

    aries2756
    Participant

    If you had an endoscopy, couldn’t you just send the study to another doctor for review?

    #830793

    PBT
    Member

    I am not a gastrenterologist, but I’ve had a lifelong problem with gastroesophageal reflux disease (GERD). In addition, I work as a Claims Examiner for the U.S. Department of Veteran’s Affairs, and I often have to evaluate Barrett’s Esophagitis and related diseases.

    Untreated, GERD can lead to esophagitis, and that in turn leads to the Barrett’s Esophagitis. I am not totally sure what that is, although what I understand is that it involves thickening and calcification of scar tissue in the esophagus, which has never had a chance to heal totally because of being bombarded with stomach acid. If Barrett’s Esophagitis is left untreated one can be at risk for esophageal cancer. I have personally been permitted by my doctors to continue on Prilosec for life. It is considered safe, which is why it’s OTC. But I do agree with the above advice about getting 2nd opinions, especially since it sounds like you’re not totally comfortable with the advice you have so far. I’m not a NY resident, so don’t know anyone there. I hope this helps.

    #830794

    Avram in MD
    Participant

    I am not a doctor, but I am a GERD sufferer and have been to a GI (so please take everything I write with that grain of salt!). Barrett’s Esophagus is abnormal looking cells caused by damage from repeated acid reflux into the esophagus. The doctor diagnoses it after performing an endoscopy. Since Barrett’s Esophagus is tied to a greater change of getting cancer of the esophagus (Heaven forbid), while the treatment plan might be no different than treatment for GERD, the GI will likely want to have more frequent endoscopies performed, perhaps once a year. Treatment is preventing heartburn.

    I was told by my GI that it is safe to take prilosec (omeprazole) or previcid (lansoprazole) daily on a continual basis (it’s certainly safer than repeated heartburn and its associated damage!). One primary reason the OTC versions have a 14 day limit is to get people who have frequent, repeated heartburn in to see their doctor.

    It’s also a good idea to make lifestyle changes that help prevent heartburn… avoiding lots of spicy or greasy/fatty foods, coffee/chocolate in high quantities, not lying down right after eating, elevating yourself, etc.

    Hatzlacha!

    #830795

    feivel
    Participant

    as far as i know it is generally called Barrett’s Esophagus not Esophagitis.

    nothing can mimic its symptoms because it has no symptoms. the only symptoms are from gerd which is the cause of BE.

    it is a pathological change (caused by long term gerd) that is diagnosed only by endoscopy and biopsy, never by symptoms.

    its only significance is that it causes a slightly increased risk of esophageal cancer, so it requires monitoring and treatment of the gerd. the barrets esophagus itself is not treated, (and i dont think it can be reversed by treatment of the gerd).

    #830796

    Health
    Participant

    feivel –

    Hi feivel -Eye Doc -Mod 80 (retired) or whatever you call yourself.

    Glad to have you back as another medical poster instead of a taskmaster.

    From Web MD:

    “Barrett’s Esophagus: Symptoms, Causes, and Treatments

    Barrett’s esophagus is a serious complication of GERD, which stands for gastroesophageal reflux disease. In Barrett’s esophagus, normal tissue lining the esophagus — the tube that carries food from the mouth to the stomach — changes to tissue that resembles the lining of the intestine. About 10%-15% of people with chronic symptoms of GERD develop Barrett’s esophagus.

    Barrett’s esophagus does not have any specific symptoms. Patients with Barrett’s esophagus may have symptoms related to GERD. It does, though, increase the risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus.

    Although the risk of this cancer is higher in people with Barrett’s esophagus, the disease is still rare. Less than 1% of the people with Barrett’s esophagus develop this particular cancer. Nevertheless, if you’ve been diagnosed with Barrett’s esophagus, it’s important to have routine examinations of your esophagus. With routine examination, your doctor can discover precancerous and cancer cells early, before they spread and when the disease is easier to treat.

    GERD and Other Complications of Heartburn

    What Is GERD and How Does It Relate to Barrett’s Esophagus?

    People with GERD experience symptoms such as heartburn, a sour, burning sensation in the back of the throat, and other symptoms such as chronic cough, laryngitis, and nausea.

    When you swallow food or liquid, it automatically passes through the esophagus, which is a hollow, muscular tube that runs from your throat to your stomach. The lower esophageal sphincter, a ring of muscle at the end of the esophagus where it joins the stomach, keeps stomach contents from rising up into the esophagus.

    The stomach produces acid in order to digest food, but it is also protected from the acid it produces. With GERD, stomach contents flow backward into the esophagus. This is known as reflux.

    Most people with acid reflux don’t develop Barrett’s esophagus. But in patients with frequent acid reflux, over time the normal cells in the esophagus may be replaced by cells that are similar to cells in the intestine to become Barrett’s esophagus.

    Does GERD Always Cause Barrett’s Esophagus?

    No. Not everyone with GERD develops Barrett’s esophagus. And not everyone with Barrett’s esophagus had GERD. But long-term GERD is the primary risk factor.

    Anyone can develop Barrett’s esophagus, but white males who have had long-term GERD are more likely than others to develop it. Other risk factors include the onset of GERD at a younger age and a history of current or past smoking.

    How Is Barrett’s Esophagus Diagnosed?

    Because there are often no specific symptoms associated with Barrett’s esophagus, it can only be diagnosed with an upper endoscopy and biopsy. In general, doctors recommend that people over the age of 40 who have a long-term history of GERD be screened for Barrett’s esophagus.

    To perform an endoscopy, a doctor called a gastroenterologist inserts a long flexible tube with a camera attached down the throat into the esophagus after giving the patient a sedative. The process may feel a little uncomfortable, but it isn’t painful. Most people have little or no problem with it.

    How Is Barrett’s Esophagus Diagnosed? continued…

    Once the tube is inserted, the doctor can visually inspect the lining of the esophagus. Barrett’s esophagus, if it’s there, is visible on camera, but the diagnosis requires a biopsy. The doctor will remove a small sample of tissue to be examined under a microscope in the laboratory to confirm a diagnosis.

    The sample will also be examined for the presence of precancerous cells or cancer. If the biopsy confirms the presence of Barrett’s esophagus, your doctor will probably recommend a follow-up endoscopy and biopsy to examine more tissue for early signs of developing cancer.

    If you have Barrett’s esophagus but no cancer or precancerous cells are found, the doctor will most likely recommend that you have periodic repeat endoscopy. This is a precaution because cancer can develop in Barrett tissue years after diagnosing Barrett’s esophagus. If precancerous cells are present in the biopsy, your doctor will discuss treatment options with you.

    Can Barrett’s Esophagus Be Treated?

    One of the primary goals of treatment is to prevent or slow the development of Barrett’s esophagus by treating and controlling acid reflux. This is done with lifestyle changes and medication. Lifestyle changes include taking steps such as:

    Make changes in your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint can aggravate reflux.

    Avoid alcohol, caffeinated drinks, and tobacco.

    Lose weight. Being overweight increases your risk for reflux.

    Sleep with the head of the bed elevated. Sleeping with your head raised may help prevent the acid in your stomach from flowing up into the esophagus.

    Don’t lie down for 3 hours after eating.

    Take all medicines with plenty of water.

    The doctor may also prescribe medications to help. Those medications may include:

    Antacids to neutralize stomach acid.

    H2 blockers that lessen the release of stomach acid.

    Promotility agents — drugs that speed up the movement of food from the stomach to the intestines.

    Proton pump inhibitors that reduce the production of stomach acid.

    Are There Treatments That Specifically Target Barrett’s Esophagus?

    There are several treatments, including surgery, that are designed specifically to focus on the abnormal tissue:

    Photodynamic therapy (PDT) uses a laser that’s inserted into the esophagus with the endoscope to kill abnormal cells in the lining without damaging normal tissue. Before the procedure, the patient takes a drug known as Photofrin, which causes cells to become light sensitive.

    Endoscopic mucosal resection (EMR) lifts the abnormal lining and cuts it off the wall of the esophagus before it’s removed through the endoscope. The goal is to remove any precancerous or cancer cells contained in the lining. If cancer cells are present, an ultrasound is done first to be sure the cancer hasn’t moved deeper into the esophagus walls.

    Surgery to remove most of the esophagus is an option in cases where severe precancer (dysplasia) or cancer has been diagnosed. The earlier the surgery is done following the diagnosis, the better the chance for the cure.

    It’s important to keep several facts in mind:

    GERD is common among American adults.

    Only a small percentage of people with GERD (one out of every 10) develop Barrett’s esophagus.

    Less than 1% of those with Barrett’s esophagus develop esophageal cancer.

    A diagnosis of Barrett’s esophagus is not a cause for major alarm. Barrett’s esophagus is, though, considered a precancerous state. So a diagnosis is a reason to work with your doctor to be watchful of your health.”

    Back to Me:

    The professional article (from Medscape/Emedicine -all one company as well as Web MD) states regarding the treatment options above -that to use them only in dysplasia (severe/high grade).

    It’s not really done in regular cases of Barretts’. And even in dysplasia, not e/o agrees to treat, some say wait until cancer develops. The PDT & EMR -they are using in place of surgery.

    #830797

    PBT
    Member

    I stand corrected. It is Barrett’s ESOPHAGUS, not esophagitis.

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