Acid Reflux-Fatty Liver

After having pain under rib area and back for some time and trouble swallowing pills recently, my doctor sent me for an upper gi barium swallow and abdommen ultra sound. Here are the results:

Upper Gi:

Preliminary film of the abdomen demonstrates no definite abnormality. The swallowing mechanism is intact. There is no evidence of aspiration or barium into the trachea. There is prominence to the cricopharygneus muscle. No evidence of esophageal stricture or mass is seen. The patient swallowed a pill. There is retention of pill secondary to esophageal spasm at multiple levels with slow passage of the pill into the stomach in the upright position.

No evidence of hiatal hernia is seen. No spontaneous or elicited gastroesophageal reflux is demonstrated. The stomach is unremarkable in size and configuration. The duodenal bulb demonstates mild prominence to the mucosal folds. No definite duodenal bulb ulcer is seen. The remainder of the visualized proximal small bowel appears unremarkable.

Impression: There is prominance to the cricopharyngeus muscle. This can be seen with chronic gastroesophageal reflux.

There is retention of the pill at multiple levels of the esophagus secondary to spasm which demonstrates slow resolution. Thsi may be seen as a sign of esophagitis. No esophageal ulceration is present.

Mild prominence of the duodenal bulb mucosal folds. This is a nonspecific finding that could be reflective of duodenitis. No evidence of duodenal ulcer is seen.

Ultrasound:

The liver is at the upper limits of normal. The liver demonstrates increased echogenicity. No focal hepatic mass is seen. There is no bile duct dilation. Portal venous flow is toward the liver. Gallbladder is unremarkable. The visualized pancreas is grossly unremarkable. Spleen is normal in size and demonstrates no focal splenic mass. Each kidney demonstrates no evidence of mass or obstruction. The abdominal aorta and inferior verna cava appear unremarkable.

Impression: Mild fatty infiltration of the liver No additional abnormality is identified.

I  have had a CBC w/diff and comprehive metabolic panelAll of my blood work was ok except for cholesterol 263 and LDL very high at 198. My triglycerides went down to 96. My last blood test triglycerides were at 197. ALT is 24 AST 16. I am taking Prevacid 30mg for the reflux

My doctor referred me to a gastroenterologist for endoscopy because of the chronic reflux. She said we need to check for Barrett's esophageus because of the chronic reflux. Now, I'm really terrified because she seems for me to be in a hurry to see the gastro. If I have Barrett's there isn't anything they can do immediately other than to moniter every year is there? Could there still be a concern that I might already have cancer? I really scared. Any help or advice or reassurance would be appeciated.

[shell1925]

From what I have read on the internet, Barrett's esophagus is not a very common occurrence of acid reflux.  I have a hiatal hernia, GERD, and esophageal erosions with no evidence of Barrett's.  The endoscopy is not bad, they put in a twilight sleep for it.  I had both done and from what my Gastro doc said the endoscopy is a much better test than the upper GI because you can see into the esophagus and beginning of stomach much better.  My upper GI showed no hiatal hernia, GERD, or the erosions so I think it is good that you're going to have an endo.

Don't worry so much about...it will be fine.  I take Protonix for the GERD and hernia.  I'm sure if the Prevacid doesn't work they will find something that will.  Good luck to you and keep us posted!

[shurely]

The endoscopy is the best way to see the esophagus and if you have a stricture (narrowing) of the esophagus they can dilate (stretch) it at the same time. I had one about 3 years ago and I feel like I'm needing it again. Feels like the lump is back in my throat. I have the erosions and stuff but they didn't diagnose Barrett's. Do you feel like something is stuck in your throat?

[Sam365]

Thanks for your reply..I'm just really nervous right now. I felt better after talking to the doc who did the upper gi, but my regular doc scared the hell out of me. I kow the endo is a much better test, I just wish she would have ordered that originally instead of the upper gi so I wouldn't have to go through all of this anxiety again. I feel like I'm on a roller coaster. Thanks again..it just helps to have someone to talk to about it.

[Sam365]

I mainly have a problem when swallowing pills, which has only happened in the last couple of months. Thats why I was sent for the upper gi. Thanks for replying, it helps to feel like I'm not alone in this.

[shurely]

When are you having an endoscopy?
Try not to worry too much it only makes it worse. I know that's hard to do!

[Sam365]

I am seeing the gastro on Feb26th. I suppose we will then make the appt for the endoscopy.