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Re: Teen-age daughter diagnosed with GERD

Posted By HFHSM.D.-ym on October 06, 1998 at 23:11:02:

In Reply to: Teen-age daughter diagnosed with GERD posted by Karen on September 29, 1998 at 14:08:11:

My 16 year old daughter was diagnosed with GERD, she has had an
endoscopy which came back negative for cancer.  She is on Propu-
lsid 4 times daily and Prilosec 2 times daily for the next 6
months.  With another endoscopy ordered for 1 year from now.
My question is, what are the long time effects of these 2
My daughter is also experiencing dizziness, and feels as if her
legs are going to give out occasionally.  The nurse when taking
blood pressure commmented that her pressure was low, but was not
any lower then her previous appointment.  Could this be associated
with this medication, however, her hands and feet were often very
cold before all of this started.
My daughters symptoms leading up to this diagnosis were severe
pains mainly on the right side, shortness of breath, pain
radiating down the right arm, and then numbness in the right arm.
I'm sorry this is so disorganized, but, my thoughts are much like
this right now.
What is the long term prognosis for a girl so young with this
condition.  And, what precisely is Barrett's Esophagus?
Thank you for this forum, it has afforded me the opportunity to
ask the questions that I have had on my mind, sometimes there is
just too much to try to understand all at once.
Dear Karen,
Esophageal cancer (adenocarcinoma) that is associated with chronic gastroesophageal reflux is uncommon but usually arises from a pre-malignant lesion called Barrett's esophagus. This refers to a change in the lining of the lower esophagus. Instead of the lining appearing pink, it looks darker like the lining of the stomach. When biopsies are taken, the glands can appear like stomach or intestinal glands. If intestinal glands are present it is called intestinal metaplasia. Intestinal metaplasia is felt to be the pre-malignant
lesion in Barrett's esophagus. When symptoms of gastroesophageal reflux have been present in an older patient (about 45 years old) for 5-10 years it is appropriate to have an upper GI endoscopy to look for the typical endoscopic findings of Barrett's esophagus. If these endoscopic findings are noted, biopsies are taken to look for intestinal metaplasia. If intestinal metaplasia is present, surveillance endoscopies are recommended every 2 years or so to look for dysplasia (glandular distortion-a sign that cancer is more likely to develop in these cells). Barrett's esophagus has been noted in 10-15% of patients who have a diagnostic endoscopy for gastroesophageal reflux. The annual incidence of esophageal adenocarcinoma in adult patients with Barrett's esophagus is about 0.8%.
Prevacid (lansoprazole) and Prilosec (omeperazole) belong to a class of medication called proton pump inhibitors. They are strong inhibitors of stomach acid secretion. They are generally highly effective in treating patients with acid peptic disorders (such as gastroesophageal reflux or peptic ulcer disease). They are newer agents, but have been successfully used in Europe in patients with gastroesophageal reflux disease with few side effects (headache, constipation, diarrhea, abdominal pain, gas to name a few). Reports of patients in Europe having taken omeperazole for five years at a time without ill effects are available. Cisapride (Propulsid) is a prokinetic agent which accelerates gastric emptying and tightens the lower esophageal sphincter. It is generally a safe drug with few side effects (mainly diarrhea). However, in patients with underlying heart disease and dysrhythmias the drug is contraindicated. Important drug interactions between cisapride and a number of medications (antihistamines, certain antibiotics and antifungal drugs) can cause fatal cardiac dysrhythmias. Patients who require long term medical treatment for gastroesophageal reflux disease might benefit from anti-reflux surgery. This procedure can
now be done laparoscopically minimizing recovery time. It is important to identify a surgeon who has specific expertise in anti-reflux surgery and to be comfortable with the risks, benefits and alternatives of this operation. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
*Keywords: gastroesophageal reflux, medical therapy, Barrett's esophagus

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