DAW - Please help

[Lynn]

Daw, I am out of my mind with the results from my endoscopy on 18 January 2005.

My Doctor and Consultant can't see why I am getting so worked up about it. There was no biopsy taken as the Consultant said he didn't see a need.

I mainly go on the Gastro/Heartburn side of the forum, but I see you are the main one for knowledge on this side of the forum.

Results

A normal gastroscopy. A very tiny island of columnar mucosa close to the OG juntion, which may represent metaplastic change, due to acid reflux. Cardia does not appear lax. Urease-v-previous H. Pylori eradication. D2 Bx taken. Her symptoms fulfil Rome II criteria of IBS. Mild chronic gastritis was seen.


I am stressing because I have picked up on the word Metaplastic. I have no medical knowledge at all and started with this reflux October 2004, I just woke up with it.

My Consultant isn't the type that likes being questioned, and my Doctor thinks the Consultants word is final. I just need to talk to someone. I feel my life is on hold. I take PPI's but have difficulty with side effects with all of them. Have just stopped taking Losec 40mg AM and 20mg PM, because the acid was giving me a sore throat. Just started taking Nexium 20mg AM and 20mg PM.

My G.P. has never heard of double dosing on PPI's.

I feel this forum is my only way to sanity, there is no one over here in the medical profession who I can talk to.

Please advise Daw - I am worried sick.

Many thanks Lynn

[daw]

"A very tiny island of columnar mucosa close to the OG juntion, which may represent metaplastic change, due to acid reflux. "

Hi Lynn,
With the above statement on your report I can see why you are worried that a biopsy wasn't taken. The doctor doing the endoscopy is only guessing at what is there.....note the use of the word "may". Unless one looks under a microscope there is no proof of what's there on a cellular level (columnar, metaplasia, etc..) So It's just a visual opinion...it does not mean you have Barrett's. Did you ask the consultant if he(she) thought it was Barrett's.

Also when the suspicious area is so close to the junction, even if a biopsy is taken, it can be subjected to sampling error (the sample might contain part of the stomach area in which case intestinal metaplasia may not be a problem).

I don't think you have to drive yourself crazy over this finding. If it is at all posssible to get a different person to do your next endoscopy and you are able to convey that you want biopsies taken of any suspicious areas, then try and do it. I don't think you have to run out and get it done immediately.

[Lynn]

Hi Daw,

Thanks you so very much for such a quick reply.

Yes I did ask the Consultant about Barretts, he thought I was going over the top and worrying unnecessarily, he said it wasn't Barretts and was probably a tiny area of stomach lining. He wasn't the one that did the endoscopy though.

If it was you Daw when would you ask for a second endoscopy.

I am so glad you understand I feel such a fool going on about it.

Many Many thanks Lynn

[daw]

Hi Lynn,
Yes I did ask the Consultant about Barretts, he thought I was going over the top and worrying unnecessarily, he said it wasn't Barretts and was probably a tiny area of stomach lining. He wasn't the one that did the endoscopy though.
..."going over the top"? Well I guess it's easy enough for him to say, it's not his body. Did they ever say how long a segment this tiny area was? The smaller it is and the closer it is to the junction the more difficult it is to biopsy and the greater chance it is the stomach lining so in theory he may be right. The key word is "probably". Educated guesses have been made without microscopic proof. Odds are in your favor that he is correct but I worry about the overall attitude.

If it was me, I'd probably ask for a second endoscopy to be done (with biopsies of the area) in 6 months to a year. This is providing you are taking medications and following all the GERD rules regarding diet, lifestyle, etc..and there are no swallowing difficulties or increase of symptoms. I pick one year because it is the usual time lapse between a first endoscopy finding Barrett's without dysplasia and the second endoscopy. The 6 months is usually for Barrett's with low grade dysplasia which is highly unlikely in your case but because no biopsies were taken you don't really know.

[Lynn]

Many thanks again Daw.

Yes I have made all the lifestyle changes, every single one.

I have real trouble with the PPI's they make me feel sicky or quite simply don't work. I have tried all five. At the moment I am on Nexium 20mg twice daily so will see how this goes.

I am going to see my Doctor as soon as I can get an appointment. As you say I myself don't like the Consultant's attitude. I want a second opinion. I just am not happy with the flippant attitude the first Consultant has.

Will keep you updated, if thats okay.

Lynn

[Mcx]

Hi Lynn

Just seen this thread, and I am really sorry to hear of the anxiety you have had over this. Consultants don't always have the patient skills and don't communicate well, even if they are excellent at the surgery. I think good patient manner is essential because as Daw says it is your body and you need the information to make important decisions.

Daw's advice is, as always, excellent.

I have Barrett's and get scoped and biopsy ever 2 years, last one January this year, month before my Fundo.

I don't see what the point of endoscopy for Barrett's is, if they don't take a biopsy, as that is the only way of determining if you have it or not.

I have my endoscopy exams at the day case unit at Stepping Hill Hospital in Stockport. The staff have always been nice, and the doctor doing the endo had classical playing when he did the procedure which was really relaxing.

[TomCarv]

Hi Lynn!!!

I was wondering WHEN I'd see You in this Forum!!! ;)

Darlin, While I agree that You should probably get another Opinion, I will say for the UMPTEENTH Time...STOP Stressing Darlin!!! :D

1. It is a SMALL Area.

2. It is Near the OG Junction, it "COULD" be Nothing more than stomach Lining!!!

3. Males (Which You are NOT!!! :D) Have a MUCH Higher rate of Developing Barrett's than Females do!!!

4. Even IF it is Barrett's, It can take YEARS (or Maybe NEVER) for it to Develop into Something Else!!!

Ask Your GP for another Referral, Maybe to Mcx's Clinic!!! and You DON'T have to do it Immediately!!!

I HAVE Barrett's and I get it Checked Every Year, No More Often than that!!!

RELAX Darlin!!!

{{{{Hugs}}}} and Prayers,

Tom

[Lynn]

Mcx, thanks for taking the time to reply. I had the endoscopy to see what was causing the reflux and according to them I don't have a hernia or a lax LES valve. I did ask where the hell the acid was coming from, but they said wait until your PH24 manometry. Why, I thought that just showed the acid level.

How are you doing with the op.

Tom, my dear dear friend thank you so much for looking me up. You are my calming influence. I went to the doctors a couple of day ago and said I wanted another endoscopy, I said I would pay private so she did agree, but I will wait 12 months. I do feel a lot more positive lately. Although I am still struggling with the dreaded PPI's. Currently taking Nexium 20mg am and pm, was on Losec 40mg am and 20mg pm but they seemed to stop working. Have a really bad chest infection at the moment (on anitibiotics) they probably arn't helping the GORD.

You just knew didn't you Tom I would gravitate to this forum. You rascal.

You have both cheered me up a great deal.

Many thanks - Lynn

[Mcx]

Hi Lynn

The Ph 24hr and manometry are two different tests.

The manometry is checking if the oesphagus is working properly and how strongly (There are some more detailed descriptions in other posts). This gives the surgeon an idea if your oesphagus will work OK with a Fundo, as it has to be able to get the food past the wrap.

Tom's right - don't stress about it, and even with Barrett's it is still a small chance it will move to the next stage, one of Daw's post here gives a very detailed account of the process, I think it's something like a 1:200 chance it may progress anyway, I may have that wrong check Daw's posts here. If it does it doesn't happen over night, Tom, I see gets checked every year, I get checked every 2 years (I have 3.5 - 4 cm Barrett's).

I hope they can diagnose your problems soon as once you know what the problem is it helps you move on and sort it.

[Lynn]

Hi,

On the Heartburn forum you memtioned a Mr Brough, where abouts is he based.

The PPI's are proving a real problem for me. Currently on Nexium 20mg twice daily but my chest is still sore. What a sod this all is.

Many thanks - Lynn

[Mcx]

He is based at Macclesfield General Hospital (East Cheshire NHS Trust).


It's a lovely Spring day here in Derbyshire, hope it's the same where you are.

[Lynn]

Its a beautiful day. Spring is here. All the usual spring time work on the farm starts now. I just love spring.

Thanks for the info. How are you doing. Well I hope.

Got the appointment for my PH24 test and manometry today. 12 April.

Have a lovely day.

Lynn