PDT and Nissen....

[Jon-Sayles]

  Hi.  I'm 46, male, and a long-time GERD sufferer (11 years) - and a sort-of-long-time Barrett's guy (3 years).  As of yet, no high-grade dysplasia.  Prilosec 20 MG - 2X/day - seems to be containing my GERD "symptoms" - for the time being.
  
  I've read about PDT and Nissen.  My Internist (who scopes me 1X/year) is dead-set against both....for me.
  His take on Nissen is that it cures only 1/2 of the time.  And of the 1/2 it doesn't cure, 1/2 of them actually develop worse symptoms!  Plus - you still need scoping and Prilosec because of the Barrett's dysplasia-risk.  
  His take on PDT is that it is much more invasive than advertised - and carries side-effects such as; endoscopies not showing dysplasia because the cells are covered!  
  
  My questions:
  1. Is this the generally accepted position of the medical profession on Nissen and PDT for Barrett's?
  2. At what point are patients considered viable for either option?
  
  Thank you for any time you take to answer these questions...........  Jon
____
Dear Jon,
Thank you for your questions which deal with an important issue.  Reflux esophagitis is a common condition but development of Barrett's esophagus is relatively rare.  We know that the symptoms of reflux can be controlled by medical treatment with Prilosec +/- prokinetic agents. Unfortunately, this therapy does not cause the Barrett's mucosa to revert to normal squamous cells.  Therefore, ongoing surveillance for dysplasia is required.  Parenthetically, the risk of cancer is related to the type of Barrett,s mucosa thgat you have.  'Duodenal' type is associated with the greatest risk of cancer development.  Yu should ask your doc what type you have.
Surgical therapy (Nissen) is indicated for those with refractory esophagitis that does not respond to medical treatment or those patients who will not take meds indefinitely. It is necessary to have a motility study done preoperatively to exclude esophageal motor disorders which could cause sswallowing problems after surgery.
We use PDT therapy for Barett,s esophagus with low grade dysplasia.  It has not been our experience to have deep burns after the procedure or to mask dysplasia.  remember that the dysplasia may be focal(restricted) in the beginning and be missed on the initial biopsies because of sampling error i.e. did not biopsy in the area which contains the dysplastic cells.
This information is presented for educational purposes only.  Ask specific questions to your personal physician.
HFHSM.D.-rf
*keywords: esophageal reflux, Barrett's esophagus
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