Do Mucosal Tongues always mean Barrets now or in future?

[Mercedes]

I am 38 years old and have been treated for GERD and on medication (Pepcid for 6 and proton pumps for 6 years) for the past 12 years. I see my Gastroenterologit annually and get endoscopes every 4 years. My last endoscope was in March 2003 and my doctor said he was almost certain I had developed Barrett's Esophagus by the visible eye from the appearance of dark red mucosal tongues extending from my stomach into the esophagus but would not be sure until he received the four biopsy's back from the lab. Well the biopsy's were negative for Barretts and postive for GERD and inflammation. My doctor said he was surprised at the result and it could be that I may have Barretts and it could of been a sampling error: meaning he did not biopsy an existing area of Barrett's. Do visible mucosal tongues normally mean you have Barrett's or can you have them with just plain GERD? Do some people have the mucosal tongues that never develop into Barrett's and onto cancer? How many biopsys will I need to go for to rule out Barrett's or is just inevitable based on the change in color (dark red) and form (tongues) of mylower esophagus? I understand that about 1 percent of people with Barretts develop cancer is there something I can do to reduce those odds beyond proton pump medication and staying physically fit. Thanks for your attention and prompt response.

[Kevin Pho, MD]

Diagnosis of Barretts requires a biopsy and is not done by simple visual inspection.  Endoscopy will detect most (80 percent) but not all cases of Barrett's esophagus. Individual variations in the anatomy of the esophagus and its junction with the stomach can make the diagnosis of Barrett's esophagus tricky.

The preferred biopsy technique should include four quadrant biopsies taken every 2 cm in the columnar lined esophagus, which should be sent for standard histologic interpretation.

If the biopsy is negative for Barrett's (as in your case), the recommendations by the American College of Gastroenterology is repeat endoscopy in 3 years.  However, if your gastroenterologist is convinced of "sampling error", then you may want to consider more frequent followup.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Spechler.  Management of Barrett's esophagus.  UptoDate, 2003.

[Mercedes]

Thanks for all your feedback. I am scheduled to receive a follow up endoscope at one year. My questions surrond the visible look of Barretts but my biopsy result showed GERD and inflammation but no Barrets's. My gastroenterologist said  it may be they missed the Barrett cells as they only take 4 biopsies from different quadrants. I was wondering if the tongue like appearance of the espophagus lining usually meant you had Barretts?? My doctor said it will probably take 2 or 3 more endoscopes and subsequent biopsies to rule it out for the present time. I am interseted in more detail on your genetic test because my father and grandmother have both have reflux for 40 and 70 years respectivley. Neither have been ever endoscoped but if Barretts is genetic I would be at less of a risk of developing cancer based on my family history.

[tessa0825]

Also, I've been told there is really no way to know who will develop Barrett's or who will continue progressing through the various stages, metaplasia, low-grade dysplasia, high-grade dysplasia or who might develop adenocarcinoma from Barrett's...The hope is to stop reflux and by doing so you hope to stop or atleast slow progression...There are no guarantees that PPIs, reflux surgery, or lifesttyle changes will stop the progression and that is why surveillance with scheduled EGDs and biopsies, reliable biopsies, are so important...Good news is that right now there is many studies and new approaches to treatment that may benefit all of us in the future......Im currently involved in one that is studying a genetic connection for this illness. There are several studies testing COX-2 inhibitors as a way of stopping the progression of Barrett's....That is very encouraging to know it is being worked on.......

[tessa0825]

I dont think anyone can tell you that you have Barretts until you get a set of biopsies and a pathology report that says you do....good luck, Tessa

[tessa0825]

In my opinion a year is to long to wait to have biopsies repeated when the Dr. has stated "it could be a sampling error".....I wouldn't be comfortable with that...


There are several genetic studies going on, probably more that I have no idea of. One is a questionaire that you fill out and then the study hosp. contacts family members to get information.......The other one is testing the relationship to abnormalities in the P53 and P6 genes as a way of establishing, at some point in time, who might be more likely to progress......Some Drs. believe in the genetic connection and some dont..Mine does, The first words he said to me were "You can thank your parents for this, they gave it to you"  Neither of my parents had this though and my 3 siblings have never had any reflux problems.....

I think the COX-2 inhibitor study is very interesting.In that study they are going on the assumption that inflammation plays a role in progression from barretts to adenocarcinoma......Ironically, I was taken off Bextra, which is a COX-2 inhibitor (that I was taking for arthritis) at the time my barretts was diagnosed and my Drs. will not allow me to take it....(obviously not all Drs. believe in this theory)There are studies at Washington University Medical School now testing that and I believe John Hopkins is doing one for it as well.....I know the one at Wash University is a 3 yr. study, Im not sure about the others.....Tessa

[Mercedes]

Thanks for all your feedback. I am scheduled to receive a follow up endoscope at one year. My questions surrond the visible look of Barretts but my biopsy result showed GERD and inflammation but no Barrets's. My gastroenterologist said  it may be they missed the Barrett cells as they only take 4 biopsies from different quadrants. I was wondering if the tongue like appearance of the espophagus lining usually meant you had Barretts?? My doctor said it will probably take 2 or 3 more endoscopes and subsequent biopsies to rule it out for the present time. I am interseted in more detail on your genetic test because my father and grandmother have both have reflux for 40 and 70 years respectivley. Neither have been ever endoscoped but if Barretts is genetic I would be at less of a risk of developing cancer based on my family history.

[tessa0825]

I hope you arent waiting 4 yrs to have the biopsies redone...If a Dr. told me the problem might be a sampling error then I would get them redone and not wait long to have that happen....Im sure this will be disputed but my Drs. say that many times they can think they see Barrett's but have a clean biopsy come back......When that happens, then the diagnosis is NO BARRETT'S...It has to be confirmed with biopsy, and there has to be goblet cells present....Believe me I have been dealing with Barrett's far more than I want to in the last yr....2 questions i've learned that are most important dealing with this diagnosis are...To ask your GI,  1. How certain he is that the samples of tissue he has removed for biopsy is an accurate representation of the entire effected area of your esophagus...In your case, it sounds like he is not sure of that, so you need the biopsies repeated...2nd question is to ask what pathology lab would he/she be sending the samples of your esophagus to if this was his/her spouse in this situation....Im not sure but I think those are very appropriate questions and should be asked more often than they are....BTW, Im no medical professional but I have personal experience with Barrett's and it certainly requires an accurate diagnosis, even if that means gettting a second opinion...