The link between esophagitis and Barrett's Esophagus

I am a 33 year old male, who was recently (last summer) diagnosed as having a hiatus hernia. On the medical notes, I believe it measured the hiatus hernia as protruding only a few centimetres out of the diaphragm, and also mentioned some small 'streaks' of esophagitis in the vicinity (permanent or temporary, I don't know)

For a little background, the endoscopy procedure that discovered this was part of a fairly thorough investigation in to numerous gastro-intestinal and other symptoms I experienced over a couple of years. These have abated in recent times, perhaps because of lifestyle changes (I have lost weight and, generally, drink less and, while I can't seem to stop altogether, have reduced my smoking significantly), although one of my doctors suggested that maybe I had had some kind of post-viral syndrome.

As I said above, I have at times experienced a few gastro-intestinal symptoms, typically in the form of reflux, sore throats, the feeling of something being stuck in my throat (one night, my voice actually went completely hoarse after I ate), occasional heartburn / indigestion and small pain behind the breastplate. Any symptoms I experience now are not as bad as they were a year or more ago, before I started looking after myself a bit better, or before my diagnosis.

However, every so often I do 'fall off the wagon', so to speak, and drink maybe more than I should. It's hard to abstain, or live like a saint, when on holiday etc. Likewise, I occasionally indulge in too much rich food. After a month or so of this, the symptoms will return again, pretty minor though I'm sure they are, compared to many of the posters on this forum.

My concern lies with the esophagitis I said the doctor had mentioned. I'm sure this must be common in a lot of people, especially those with hernias, GERD, or other such complaints. I'd imagine this inflammation probably comes and goes, possibly, unless you are being really unkind to your gullet on a regular basis. I have read about Barrett's Esophagus, however, and how something like 12% of people with esophagitis will eventually develop this condition (a precursor to throat cancer, I believe).

As I said earlier, I am only 33, and am just trying to understand if I should, perhaps, take more care with my lifestyle. I have other friends with hiatus hernias, who seem to get by symptomless despite their excesses. Maybe you could explain the link between esophagitis and Barrett's Esophagus and whether or not my kind of case ever leads to such a condition?

[Kevin Pho, MD]

Hello, thanks for asking your question.

Most cases of esophagitis is from uncontrolled GERD.  GERD and esophagitis are risk factors for Barrett's esophagus.  The Barrett's itself does not cause symptoms, rather this should be screened for in patients with chronic reflux or esophagitis.  

The mean time to diagnosis is at age 55.  Barrett's esophagus appears to be uncommon in blacks and Asians. The prevalence in Hispanics is similar to Caucasians.  The studies suggest Barrett's occuring in 3-12 percent in patients with GERD.

Of course, it is difficult to predict which kind of cases proceed to Barrett's.  If you are having chronic symptoms of GERD, it is worth doing surveillence endoscopies to evaluate for Barrett's.  5-10 patients with Barrett's develop esophageal cancer.  In your case, I would improve your acid control since you are having symptoms such as globus sensation (i.e. feeling in the throat) and reflux.  

Treatment of the GERD should be with proton pump inhibitors or H2 blockers.  If medications cannot control your symptoms, surgical management should be considered.  

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.

Thanks,
Kevin, M.D.

[tessa0825]

Barretts esophagus dvelops in about 5-10% of people with chronic (long term)  untreated acid-reflux...It occurs from the amt of acid refluxing into the esophagus and causing the cells to change from the normal (squamous cells) to a specialized columnar cells, those that resemble the ones that are NORMALLY found in the stomach. In a small amt of people diagnosed with barretts with metaplasia only, they will continue to progress to dysplasia and even some will continue to esophageal cancer...Once those cells change, they will not change back, so trying to stop the acid and control the reflux becomes the object of tretment....Lifestyle changes, raising the head of the bed, medication, and for some fundoplication surgery......Reflux normally occurs because of a weakened LES(lower esophageal spincter) muscle....That is the muscle that is at the base of our esophagus and it is supposed to stay tightly closed except when we are eating or drinking and then it opens to allow what we have consumed to enter the stomach from the esophagus....WHen it becomes weakened then a portion of our stomach pushes through and lays in our esophagus (hiatal hernia) thus our LES muscle (to some degree) is always open allowing the acid to reflux.....Fundolication is a good choice for alot of people as it reapirs the weakened LES by wrapping a portion of the stomach around it and most people dont even require PPIs afterwards....I think when barretts is involved it becomes a harder decision to make...Atleast it is one Im struggling with....I recently (two weeks ago)had a biopsy that showed some high-grade after being at low-grade only for months....My dr sent it all to another lab for a comparison report and that report came back conclusive for low-grade with no mention of high-grade...My Nexium has been raised to 100mg per day now, I have went from 165lbs (8months ago) to 119.....It is certainly a roller-coster illness...Im going to be evaluated at Cleveland Clinic (after biopsies are redone in July) to find what my next actions should be....I so far have refused fundoplication surgery as Im to afraid the wrap would hide the barretts area making it harder to see at EGD and harder to biopsy...If Im progressing I prefer to know it and deal with.....I guess the most important thing for you is to stop the acid and by doing so you stop anymore damage...I had heartburn for 25 yrs before I was diagnosed and I had no idea anything was wrong, I thought everyone had heartburn!!!!....Hope this helps......Tessa

[Frankie42]

I just read your comment re: Barrett's Esophagus.  I was diagnosed with this last June.  I will be "scoped" again next month.  I'm hoping that it has not advanced.  You stated you dropped a lot of weight.  I am really struggling with that now.  My doctor said it is very important to get my excess weight off to help ease the reflux.  Any suggestions?  I still struggle with the GERD diet.  I have made vast improvements; but am far from perfect.  My biggest problem is chocolate.  I am a chocaholic.  I will do very well with avoiding it for about 10 days and then I go crazy and have to have some.  I was also wondering if you will be going to the Cleveland Clinic that is actually based in Cleveland.  I live about 45 minutes from Cleveland and wondered if I should pursue a specialist there.  Have you already seen a doctor from the Clinic?

[tessa0825]

Hello...You didnt mention but do you have any dysplasia with your Barrett's?...If not, then that is very good news..If you can get the reflux under good control and stop anymore damage from occuring that should help alot......I havent seen a Dr. at Cleveland Clinic yet...Im having an EGD and my biopsies redone on July 22nd,(my last biopsy in April showed some areas of High-Grade so I have been in a panic every since) at that visit my GI Spec. and I are going to talk about me meeting with a surgeon at Cleveland Clinic....Yes, it is the CC that is in Cleveland...Im in Ohio, about 4.5 hrs from Cleveland, but still Ohio....Dont do what I did to take off the weight!....I travel alot for work and didnt know for sure what to eat, so I only ate cream of wheat and noodles for 8 months....Now, Im seeing a nutrionist every week and starting to add more to my diet.....The foods we really need to avoid are coffee, caffeine, spices, tomato products, CHOCOLATE :), cola, pepper, fatty or fried foods,  citrus fruits, mints, and basically anything that we know bothers us...Also, no alcohol or tabacco products.....My worst vise is that I smoke...I could give up eating but Im still having a hard time with smoking....Im very honest with my drs. about it, and they are trying to help me with it.Im down to 1/2 pk a day now so I am improving.....With this diagnosis we are already under alot of stress,when you stop eating everything that taste good, have added stress of a demanding profession, and have to quit smoking all at the same time...It is almost next to impossible.....Here is a very good site that explains in detail every question I ever had about barretts and also it explains the cell changes that occur with this disease....
http://www.barrettsinfo.com/content/1_what_is_barretts.htm
Also, if you would like anymore info, you can email me at m_catarina***@**** care....Tessa

[Joe E]

I was diagnosed with Barrett's several years ago and have had GERD for several years. When relief was no longer obtained through medications, the chief surgeon at my work sugested I consider surgical options. After observing the procedure, I had a Nissen Fundiplication, which creates a fold in the stomach that acts like the sphincter at the junction of the esophaegus and stomach. NO ACID REFLUX! I again enjoy foods like chocolate, pizza and salsa without the pain! Moderation, however, is very important to consider with these foods! Consult with your physician on this or other surgical options that stop GERD or repair Hiatal Hernias

As for the Barrett's, biopsies were negative! I continue to have that monitored through endoscopies, as well as colonoscopy checks. I am in an elevated risk catagory, with an immediate family history of colon, liver, and kidney cancer. EXAMINATION AND EARLY DETECTION is our best line of defense.

[tessa0825]

Hi Joe, Im so happy your surgery has done well for you, most people I have spoken with that have had lap nissen mimic your words...I am meeting with a team of Drs. at the Clevelnad Clinic later this summer to discuss some options, as I have now had some areas read as high grade at my last biopsy....Please continue with your surveillance EGDs and biopsies as, sometimes, having fundoplication surgery can make barretts harder to see and harder to biopsy at EGDs....Good luck adn take care....Tessa

[Keekee24]

A related discussion, Complicated Med Hx was started.