Barrett's relationship to Crohn's Disease

[Carole__0]

  I am a 51 year old female who has had Crohn's Disease since I was 20.  I have been a most fortunate person in that I've not had a lot of problems since age 30.  Two years ago I had terrible problems with my esophagus.  The gastroenterologist ran an endoscopy on me.  He felt convinced I had Barrett's, but the lab reports said no.  I went back for two year check, but also informed him for several months I've had problems with pain in abdominal area (gut).  He still feels I have Barrett's, but we are waiting on reports to come back.  The pain is still really bad in the abdomine, but is different from earlier years of onset of Crohns.  Presently, he has placed me on 30 MG Prevacid 2 times a day and .125MG Hyoscyamine 2 times a day.  I am very confused.  Since Crohns can go anywhere in the digestive tract, I worry that's what is going on in my Esophagus and perhaps spreading more in the small bowel.  Most of the pain is centered near navel, but is all around the intestinal area, even my stomach gets sore.  Adding to all the worry is the fact that 2 years ago, he informed me that biospsies from my colonoscopy showed I have pre-cancer cells present.  
  Are all of things related?  I have ignored pain for many years and had just accepted it as a part of my life.  The pain is now too much.  How can I get him to understand I'm not over stressing the amount of pain I'm in.  Also, I am so tired out and have to keep going, that I just drag in everything I do.  I'd just rather sleep all day and ignore this problem rather than fight geting help as well.  Having an HMO doesn't help, either.
  I really do appreciate an helpful information you can give me.  I live in the Philadelphia, PA area.  From the posts I have read, your information is really helpful for those of us suffering from digestive tract ailments.  Sorry post is so long.
  Carole
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Dear Carole,
You are correct that Crohn’s Disease can involve the entire GI tract from mouth to anus.  Sometimes, physicians can have difficulty confirming active disease and therefore there is a delay in starting treatment.  
Your e-mail raises several interesting issues.  Barrett’s esophagus and Crohn’s Disease can both involve the esophagus although there is no compelling evidence that one condition predisposes to the other.  Biopsies of the esophagus  can determine conclusively whether you have Barrett’s esophagus.  It can be more difficult to distinguish between Crohn’s involvement of the esophagus and reflux esophagitis.  An empiric trial with antireflux treatment including medication (Proton pump inhibitors e.g Prilosec and prokinetic agebts e.g. Cisapride) is indicated.
You do not state if you had small intestine and/or colonic Crohn’s Disease or whether you have required surgical intervention. Your complaints of diffuse abdominal pain and fatigue may represent a flare of your Crohn’s disease although other conditions must be considered.  At this juncture it would be appropriate to have barium studies of your small intestine.  Finally, the colonic precancer cells may be related to the Crohn’s Disease.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.

Even though you belong to an HMO, you may consider requesting a second opinion from your plan.  If you obtain approval for an out of plan consultation and wish to be seen at our institution, Henry Ford Hospital, please call our PHYSICIAN REFERRAL LINE at(313) 876-2393 and request consultation with Dr. Fogel, one of our experts in the diagnosis and treatment of Crohn’s Disease.
HFHSM.D.-rf
*keywords: crohn’s disease, Barrett’s esophagus
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