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Barretts Esophagus

I am currently aged 30, male, Asian, non-smoker and have been suffering from constant burping and bloating since 2007. I have had two upper endoscopies; once in Nov'08 and the 2nd a few weeks ago - Mar'12.

A few days ago the biopsy result from the 2nd endoscopy came back with the following:
"Oesophagus: Sections show squamo-columnar junction, including columnar mucosa of gastric cardiac and fundic types. There is intestinal metaplasia, consistent with a clinical diagnosis of Barrett's oesophagus. A mild chornic inflammatory cell infiltrate is present in the lamina propria together with focal activity. There is no evidence of dysplasia or malignancy. No ulceration is identified. The squamous epithelium shows changes of reflux oesophagitis.

After I awoke from the procedure, the Gastroenterologist stated that my overall condition was better than what he saw during my last endoscopy back in Nov'08 which showed "Eroded, inflamed gastro-oesophageal junction, with no Helicobacter infection, intertinal metaplasia, dysplasia or malignancy". It wasn't until my GP informed me of my biopsy results that I got the surprise of my life - that I have BE.  No further information were given other than telling me to go and see my Gastroenterologist, with the earliest appoint. in another months time.

My GP had prescribed Somac (Pantoprazole) and Tazac (Nizatidine) after my 1st endoscopy, but it wasn't until Jan of this year 2012, that I started taking the medication on a daily basis.

My questions for you today are the following:
1) How could there be such discrepancy between what the Gastroenterlogist saw and what the biopsy showed.
2) Even with medication and dietary changes, how quickly can the BE progress.
3) Other than the wait-and-see approach, what other pro-active measures can I take to get rid of BE.
4) For the past week, I seem to be getting throat constriction / lump sensations and a bit of hoarse voice.  Are these anxiety related or complications from BE/GERD?
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1760304 tn?1316457159
Dear ForEvaUrz,

Thanks for writing in.

I would first like to clarify that reflux esophagitis and Barrett’s oesophagus are a continuum of the pathology associated with gastroesophageal reflux disease. Repeated injury to the lining of the oesophagus secondary to reflux causes a change in the type of the lining epithelium to the intestinal type of columnar epithelium, as it ( columnar epithelium) can withstand acid better. These changes occurs over years of uncontrolled reflux

1)     At the gastroesophageal junction, the change to Barrett's mucosa may be patchy and may sometimes be on a random biopsy. Visualisation in the routine white light endoscopy may not clearly show the Barrett's mucosa and hence the endoscopist may not target the lesion and the biopsy report will not show Barrett's mucosa. These days, there are new endoscopes with special imaging which highlights the Barrett's mucosa and allows for accurate targeting the biopsy. These are the reasons for the stated discrepancies and the apparent rapid progression.

2)     The progression of Barrett’s oesophagus depends on a host of factors, many of which are molecular in origin. Although people with Barrett’s have a 30—125  fold increased risk of esophageal cancer, the risk can be decreased by proper management of reflux.

3)     When Barrett's oesophagus develops, it is usually not reversible. However, further progression can be prevented by avoiding further reflux. Take a twice a day dose of proton pump inhibitor along with a prokinetic like domperidone. You would also need some lifestyle changes like:
a.     Not lying down for 2 hrs after meals
b.     Having small meals at frequent intervals rather than having a few large meals.
c.     Elevating your head while lying down
d.     Breathing or diaphragmatic exercises
e.     Lose some weight

4) The symptoms that you have stated can occur with reflux but can also be worsened by your anxiety.

Hope this answers your query. I will be available for follow up.

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Best Regards,
Dr. Poorna Chandra
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