Barrett's Misdiagnosis - What Do You Do?

[the-wombat]

When I awakened from my last endoscopy, the gastroenterologist pronounced, "You have Barrett's esophagus."  Of course, I was troubled.  However, the biopsy indicated NO Barrett's; rather it was stomach tissue.  My gastro uses a term for this: nondistinctive Barrett's, but from my reading this is not an accepted, current definition.  So my question is this: should I terminate my gastroenterologist for his premature pronouncement?  And a corollary question: should a doctor wait for the biopsy before making any pronouncment, or can Barrett's ever be determined visually at the time of endoscopy?

[imkindly]

Here's a good page on Barretts esophagus (and how it's supposed to be diagnosed):
http://www.fhcrc.org/science/phs/barretts/plain.htm


PS---that link came from a larger page at
http://www.gastro.net.au/diseases/barretts.html

Hope this helps.

[Wilson]

It sounds to me like the doctor who scoped you should maybe have told you he SUSPECTED Barrett's but would wait til he got the biopsy report before confirming it. But it also sounds like what he told you ended up being basically correct, at least according to a loose definition of Barrett's. When there's stomach tissue in the esophagus that means there's dysplasia going on - cells are changing, and your doc probably figured Barrett's was a "close enough" diagnosis at the time. He also may have assumed you'd know whatever his impressions were from the scope would have to be confirmed by the lab before you would have an official diagnosis. So I wouldn't necessarily cut him off for just that, if you think he's good otherwise.

[imkindly]

I thought I'd add this real quick just in case it's any help to you.
I subscribe to MedScape's MedPulse (they send me an email once a month, with links to new medical articles). Today I got the December edition, and this is in it:

GASTROENTEROLOGY CME CIRCLE - NEW HORIZONS IN ACID SUPPRESSION OF GERD:
EVALUATION OF THE EVIDENCE
Covering the spectrum of disease from nonerosive reflux disease to Barrett's esophagus, this program discusses the latest clinical issues and strategies.
Gastroenterology CME Circle - 2001 Rush-Presbyterian-St.Lukes Medical Center
http://gastroenterology.medscape.com/45613.rhtml?srcmp=gas-113001

[the-wombat]

They are recommending monitoring every two years; however, I read the following from the web site:

http://www.barrettsinfo.com/content/3b_what_is_histology.htm

Here are extracts that indicate that stomach metaplasia should NOT be considered as Barrrett's:

"The normal esophagus is lined by squamous cells. In Barrett’s esophagus, the normal lining is replaced by an abnormal lining called specialized intestinal metaplasia. Metaplasia is the term used for a change in the type of cells in a tissue to a form which is not normal for that tissue. Barrett's metaplasia looks like a cross between stomach tissue and intestinal tissue. Barrett’s metaplasia, like the stomach and intestinal tissue produces mucous. The mucous producing cells or goblet cells stain blue with a special stain (Alcian blue). The Alcian blue stain can be used to differentiate Barrett’s tissue from normal stomach tissue that does not have Alcian blue staining goblet cells."

"In spite of this, a diagnosis of Barrett’s esophagus is sometimes made based on an outdated definition of the disease. Occasionally patients, who have stomach lining in the bottom of their esophagus and NOT specialized intestinal metaplasia, will be given a diagnosis of Barrett’s esophagus. Unfortunately, this causes unnecessary anxiety on the part of patients who have been diagnosed with a pre-malignant condition that they don’t really have. ONLY SPECIALIZED INTESTINAL METAPLASIA OF THE ESOPHAGUS HAS BEEN SHOWN TO BE PRE-MALIGNANT AND WARRANTS PERIODIC ENDOSCOPIC CANCER SURVEILLANCE."

So, either (a) this web site is right or (b) my gastro is right.

General comment: although I believe my gastroenterologist is technically thorough, we have poor communication and quite frankly I feel intimidated by him - something I usually do not feel!

[the-wombat]

Thanks for your interest.  I am posting here my current status in case you have any insight!

Here is my background: diagnosed with GERD and biliary diskinesia; gallbladder taken out. Symptoms partially better after gb out.

Medications: Aciphex 40 mg twice a day - quadruple therapy! (demeester (sp?) score of 38 on 20 mg twice a day; 62 with no meds); carafate 4 tsp 2 times a day; zoloft 25 mg once a day.

Current symptoms: Esophageal discomfort. Two types:

(1) A gripping feeling as if someone is squeezing my (lower) esophagus; this at one time could me induced by eating fat; no longer, but it still happens. Usually worse in morning, regardless of what I eat. Gastroenterologist said this whole thing was gallbladder related, not reflux related. Still get this after the gb out. I have good bile flow. When symptoms get real bad (i.e., squeezing feels stronger) sometimes my eyes burn! Belching provides a brief (10 second) reduction, but no solution.

I CAN MAKE THIS FEELING OCCUR AT WILL BY LIGHTLY POKING MY ABDOMEN. (Just below the belly where they did the incision). Haven't tried elsewhere.

(2) A feeling of something in my esophagus, not solid, but like mucous. This correlates to certain foods (e.g., soy milk, or cows milk). I have noticed sometimes it goes away when I take a low dose of the decongestant pseudophed!

I noted when I began to take Zoloft a certain class of reflux (my term) symptoms disappeared. The symptoms were a sense of presence in the lower esophagus which prompted a desire to swallow, but I could not swallow. I relaxed and then swallowed.

Food goes down OK. Cardiological workup showed nothing.

[Rosiemoore]

A related discussion, Barrett's Misdiagnosis was started.