Question Title: GERD with Barrett's and Fibromyalgia

This year many long term symptoms have been finally identified.
I was diagnosed with fibromyalgia and myofascial pain syndrome.
At the same time I rec'd the GERD dx. Recently I had a ba swallow
and two weeks ago an egd w/ bx. I got the call this week that it
is probably Barrett's esophagus (some slides not back). Of course
with my fibro comes reactive hypoglycemia. I feel like a junkie!
I need guidance with diet, dietary restrictions or advice and the
long term outcome for Barrett's, such as follow up over the years.
The oft associated dx of adenocarcinoma is not exciting at 47!
I find myself directing my own care because of the fibro. I have been
treated for so many years for sinus and chr tracheitis, and one
Zantac at night cured it, but now it's prilosec bid and propulcid qid
in addition to my fibro meds. HELP!!!
Dear Kathleen

Gastroesophageal reflux is a chronic condition that probably has been around for quite some time. Esophageal cancer (adenocarcinoma) that is associated with chronic gastroesophageal reflux is uncommon but usually arises from a pre-malignant lesion called Barrett's esophagus. This refers to a change in the lining of the lower esophagus. Instead of the lining appearing pink, it looks darker like the lining of the stomach. When biopsies are taken, the glands can appear like stomach or intestinal glands. If intestinal glands are present it is called intestinal metaplasia. Intestinal metaplasia is felt to be the pre-malignant lesion in Barrett's esophagus. When symptoms of gastroesophageal reflux have been present in an older patient (about 45 years old) for 5-10 years it is appropriate to have an upper GI endoscopy to look for the typical endoscopic findings of Barrett's esophagus. If these endoscopic findings are noted, biopsies are taken to look for intestinal metaplasia. If intestinal metaplasia is present, surveillance endoscopies are recommended every 2 years or so to look for dysplasia (glandular distortion-a sign that cancer is more likely to develop in these cells).

The lifestyle modifications that are considered helpful in patients with gastroesophageal reflux are called anti-reflux measures. Foods that can decrease lower esophageal sphincter pressure should be avoided. Those foods include: coffee, tea, cola beverages (with and without caffeine), citrus drinks, fatty foods, spicy foods, onions, peppermint and chocolate. Medications such as aspirin or non-steroidal inflammatory agents (for example: ibuprofen, naproxen etc.) can be irritating to the stomach or esophagus. Other medications that decrease lower esophageal sphincter pressure are theophylline and albuterol (medicine for asthma) and calcium channel blockers (such as dilitiazem, nifedipine for high blood pressure and angina). It is important for you to review the list of your medications with your doctor. Other helpful lifestyle changes include: elevating the head of your bed on 4-6 inch cinderblocks or using a wedge under the mattress; not eating at least 3-4 hours before bedtime; eating smaller, more frequent meals and avoiding smoking and alcohol. I hope you find this information helpful.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you wish to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.

HFHSM.D.-ym
*Keywords: hiatal hernia, gastroesophageal reflux, anti-reflux measures, Barrett's esophagus, esophageal adenocarcinoma

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