Pre -Barrett's esophagus, how worried should I be?

I'm 40yr old male suffering from GERD mostly left untreated for many years.  Finally started exercising and eating healthy and it helped acid reflux big time. Also taking Prilosec.  Started having pain in gb area and nausea.  Ultrasound of GB negative for stones.  Had Hida scan, showed 24% ejec fraction (horrible pain and nausea during ckk injection).  Still have gb but discussing if it should come out or not but my pain continues if I eat anything fatty or spicy at all so I think it will.  Had EDG that showed no H Pyloir, quite a bit bile in my stomach, and inflammation which he took a biopsy off.  The doctor told me I had "Pre-Barrett's Syndrome with some dysplasia but it didn't look like the real nasty stuff."  He went on to very briefly explain what it was then talked more about my gb and also put me on Reglan.  He said I would be scoped again in a year.  I didn't ask many questions.  Went home and read about Barrett's and I am now terrified.  I know what it is and my supposedly low chance of cancer is.  My question is how scared should I be?  What the heck is Pre-Barrett's and does that always turn into  Barrett's?  I have permanently changed my eating habits and I seldom drank any alcohol anyway but should I be so concerned that I NEVER drink alcohol or have a "good" meal again? Thanks.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation for your symptoms.

The findings of the endoscopy would put you at risk for future development of Barrett's.  Periodic endoscopy to ensure there is no progression is a reasonable approach.  However, treating the GERD needs to be done.  If the GERD continues (and can be measured via a 24-hr pH study) despite maximal PPI therapy, you may want to consider surgery to solve it (such as a fundoplication).  

If the gallbladder is responsible for the symptoms, removing it can be considered.  An ejection fraction of 24% is low, and small studies suggest improvement when the gallbladder is removed in these cases.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Isabeljo]

I noticed your post said you doctor placed you on Reglan.  Be careful with it.  If you start to become depressed and weak, then tell your doctor right away.  Some people respond to Reglan this way; others do not.  This is not intended to induce fear, but to just be aware of your reactions to Reglan.  BTW, I had GERD surgery and my esophagus was ulcerated from top to bottom with pre-barrett's signs.  After the GERD, my esophagus completely healed.  Do not worry about this. Your body can heal.  I do have one to 2 cups of coffee (mixed caffeinated/decaffeinated) in the morning only, a glass of wine occasionally, never eat late at night, rarely take anti-inflammatories, eat low fat meals but occasionally eat something fatty, walk, etc., and my esophagus is still fine according to the post surgical endoscopies that were done later. If you have any questions, you can contact me at ***@****.

[miknan]

Thank you so much taking the time to respond.  Your message is very uplifting.  I read about those effects of Reglan and I was getting depressed and started to have insomnia but that started immediately after reading stuff on the internet about Barrett's and before I filled my prescription 2 days later.  I also have been very tired but for the twelfth straight day I've woke up after 3-4 hours of sleep and haven't been able to sleep again.  Workouts on the treadmill I breezed through seemed a bit harder but again I was very tired before I began.  Reglan or stress?  You would think it would be easy to just change meds but the Reglan has helped a lot, no nausea for 3 straight days.  I called my doctor.  He told me I had signs of Barrett's but had no dysplasia.  I thought WHAT??  I thought I did have dysplasia and he said no.  I felt a 500lb weight come off my shoulders.  This doesn't mean I am going to change my new lifestyle but it was certainly the Big Ben of wake up calls to take care of myself.  This happened yesterday and now I read your mesage and I have hope that I can lead a normal, even healthier life than before.  Now I just have to decide what to do about this gallbladder which hasn't bothered me much at all since I adopted my low fat diet.  You obviously have had a much tougher time than me and I hope for your continual good health.  I don't know how I could ever help you out since you know much more about this than I but here is my email in case you ever have any questions: ***@****  Thanks again.

Mike

[miknan]

Sorry I butchered your name on here, looks like I am not the only one though.  I did't read your own post to this board and see that you have other stuff going on besides your esophagus.  Good luck to you.

[TJV]

The doctor told me I had "Pre-Barrett's Syndrome with some dysplasia but it didn't look like the real nasty stuff."

  That sentence makes no sense . There is no such thing as pre Barretts , it doesn't exist,

GERD puts people at increased risk for Barretts , is that what your doctor  means by pre Barretts ?

  The only way Barretts can be diagnosed is by biopsy ,   ... not visual......  either the biospsy  shows Barretts or it doesn't .   It can show Barretts low grade, high grade , Barretts with dysplasia or without.
  
Also If  you have dysplasia , you have Barretts . There is no such thing as dysplasia of the esophagus, unless there is Barretts .  There is Barretts with or without dysplasia , the latter being more serious . ( Barretts, a pre cancerous condition  cannot turn into cancer unless dysplasia is present first . )

  You should obtain your biopsy report , and  pin your doctor down as to what he means by pre Barretts , or signs of Barretts - it makes absolutely no medical sense . Also ask for a gastric emptying test for the nausea. Here's a Barretts  message board you can read and ask questions  http://pathology.jhu.edu/beweb%5Fchat/

[miknan]

Thanks for the info.  I am confused about what my doctor meant.  When I talked to him on the phone last he said I do not have dysplasia.  I am not sure exactly what he meant by the pre-Barretts.  My guess is Barretts without dysplasia.  The info you and Isabeljo gave me is the type of info I was looking for when I paid to have this posted.  Thanks.

[TJV]

Pre Barretts is not Barretts without dysplasia . Barretts without dysplasia is Barretts . There is no such thing as pre Barretts . It doesn't exist .

[miknan]

That is good to hear.  I must not have Barrets at all then.  Maybe he saw something that looked like it had the potential for BE and would keep checking.  He did take a biopsy but I must be okay.  I big wake up call for me.

[celine149]

TJV is absolutely correct. There is no such thing as pre-barrett's! Either one has barrett's or they don't. It can only be diagnosed by biopsy. Barrett's without dysplasia is called barrett's with metaplasia only.  

I can't belive the Doctor of this board didn't explain this to you. You need to nail your doctor down and get some straight answers. You could also have your biopsy slides sent to one of the big academic hospitals for a second opinion.  

[brian55]

I was just diagnosed with Barrett's.  My physician put me on aciphex(20mg's 1 x day)I'm curious, prior to my Endoscope the only issue I've had in my life with anything pertaining to heartburn was a month earlier i was feeling a little heaviness in the chest.(my primary physician prescibed omeprazole)  "How could one have barrett's when i haven't experienced any issues prior to the chest heaviness?"  Also, is there a significant difference between "omeprazole" "and aciphex"  both 20 mg's.

[jc2859]

I was diagnosed with Barrett's 7 years ago.  You can have lots of symptoms of GERD other than heartburn.  They include fullness and bloating in your stomach and abdomen, which most women tend to think are our hormones, waking up with a sour taste in your mouth from stomach acid and developing a chronic cough from stomach contents going into the bronchials rather than back into the stomach.  If you also have other issues such as smoking or sinus problems you may miss these warning signs.  My doctors tell me the important thing to do now that I know I have Barretts is to get scoped regularly (every two years now that I have gone this long without any dysplasia) and control the GERD with a low fat diet and not eating after 6 pm to avoid any further damage to the esophogus.  Barretts can't be repaired, but it can be managed by keeping an eye on it and eating healthy.

[cbmcdonald]

I was diagnosed w/ barrett's a little over 2 years ago.  I too really didn't have many symptoms.  I am now on Aciphex and have revamped my diet and things seem to be under control, but on occasion I will have "fatty" food and stray from the diet.  The following day, I seem to find myself nauseous and extremely tired.  Is this normal?  I run and lift weights 4-5 days a week, but sometimes I feel just too run down/nauseous etc from what I ate the night before.  Is this a common side affect from Barrett's?   Thanks.
Chris

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