What is the consensus for genetic factors

[cpadpl]

I am a new person to this website. Am approx. 30 with acid reflux, on Nexium. What is the general concensus on the hereditary factor involved in Barrett's esophagus (i.e. why most people with GERD don't get it). From what I have been reading (what little I have been reading, I'm by no means an expert), there doesn't seem to be any link.

The thing I wonder about when doctors study herediary links is the fact that until very recently many people didn't keep records or know what loved ones died from. For instance, my great-grandmother died very young, but no one knows of what. The doctors of the day thought it was cancer, but we never knew what type. It wasn't until my grandmother developed breast cancer, and then my mother and then her sister, that we maybe started putting two and two together.

I'm just curious, I'm no doctor or purporting to be one. I ask because I know a young lady (36) with two children whose father died of esophagus cancer at 50. She has no GERD symptoms whatsoever and has told her practioner about his death, but he says there's no reason for her to be checked or even concerned. Does he sound crazy?

Also, my practioner (who has now sent me on to a gastroenterologist) first wanted to see how I responded to medication and diet changes over a period of 6 months to a year before doing a barium swallow or sending me on to the stomach doctor (to have him order any endoscopy and further medication changes). Is my practioner crazy too? Why no rush?

All of your comments and knowledge would be welcome. This is all new to me. Heck, I remember back in the 70s my dad and uncle used to joke about heartburn while drinking whiskey and smoking cigarettes. Who would have known?

[Dante]

I believe it was at www.barrettsinfo.com9 that stated almost all doctors now accept that Barrett's is caused by acid reflux and not hereditary.

[daw]

cpadpl, After reading many posts on the esophogeal cancer forum and Yahoo's GERD/Barrett's group, I 'm inclined to believe heredity does have some role. There may be an inclination to GI problems in families.

Whole families (father, brothers,sisters) have ended up with Barrett's and in some cases EC. In my family my brother in his 40s was diagnosed with GERD a year or two before me. My parents never having been diagnosed.....I do remember my mother having difficulty with certain foods getting caught in her throat and my father complaining of tomato sauce bothering him.

Whether members of a family have a tendency to eat similarly or drink alcohol and/or smoke can also make a difference.

You said " Also, my practioner (who has now sent me on to a gastroenterologist) first wanted to see how I responded to medication and diet changes over a period of 6 months to a year before doing a barium swallow or sending me on to the stomach doctor (to have him order any endoscopy and further medication changes). Is my practioner crazy too? Why no rush?"

In my opinion any heartburn problems that need prescribed medications should be checked out by a GI with an endoscopy....especially if you know there is a history in your family. People can have Barrett's and not realize it. Knowing what I know now, I wouldn't wait to have an endoscopy.
Also remember...the severity of your symptoms does not reflect the severity of what might be going on in your body.

[cpadpl]

daw

Thanks for the info. What perplexes me is why some people get Barrett's and some don't even with significant GERD. GERD (or stomach problems) have been a big problem in my family. My grandfather died rather from a self-inflicted "wound" - he had a stomach ulcer (he had been taking antacids all his life) and was also tripling the dose of aspirin he was supposed to take. Bottom line is the ulcer sprung a leak and he bled internally to death (he had an endoscopy right before he died and they found it, but it was too late). My father has had heartburn all his life, smoke and drank quite a bit, and had an endoscopy and nothing. His GERD used to get him up in the middle of the night. Why, with heavy drinking, smoking 2 packs a day, and GERD for 30 years, and no Barrett's? He is on 40mg Nexium and STILL has to take Tums!

I don't plan to wait on my endo, I'm seeing my new specialist in a few weeks. The funny thing is that you end up waiting anyway. I made this appointment in December, but the first they could get me in is February (darn snow birds). Also, I refuse to have an endo (or anything else) done locally, and will travel up to the Mayo Clinic in Jacksonville, Fla. for any testing like that. It usually takes 2 to 3 months to get in there. I just feel better with true experts looking for my problem than the local yokals (no offense against them).

Re "needing to be prescribed meds", is a point I'm slightly ashamed about. I started taking Tums in my college days occasionally, and then moved up to Zantac, not because it worked better, but because I wanted to be able to go to a bar and drink all night without having to remember to bring a tums. I wanted a pill so I could go out and party until 2am drinking tons of alcohol, then stop by Subway and get a foot-long BMT, chips, 3 cookies, and a large Coke, go home and eat it, then go to bed and not wake up with heart burn.

When my GP initially asked me is my Zantec working okay for me and I said "most of the time", what I was thinking in the back of my mind was "most of the time, even though on a good day I drink 2 cups of coffee in the morning, 8 sodas throughout the day, get home at 9:00pm, eat a huge dinner, and then go straight to bed."

Looking into all of this stuff is an eye-opener. 1) I feel ashamed that I didn't take my health more seriously in my 20s at least enough to think it was more important than being able to consume alcohol, and 2) I am even more ashamed (now that I find) that there are people in desperate battles with hearburn who are taking Nexium and other meds and still can't get relief. Here I am popping pills so I can eat my cake and have my 4 Martinis too. I probably shouldn't be on Nexium. I probably shouldn't even be on Zantac.

Nne of you with serious GERD should have any sympathy for me, I made my own bed and now I have to lie in it.....

[daw]

"1) I feel ashamed that I didn't take my health more seriously in my 20s at least enough to think it was more important than being able to consume alcohol..."

C. don't be so hard on yourself. When you're in your 20s you feel immortal.
Right now my sons are both in their 20s. One loves to drink beer and the other is a fast food junkie. But I didn't eat or drink improperly...and now I have GERD and begining Barretts. In my case I think it was years of stress.

"2) I am even more ashamed (now that I find) that there are people in desperate battles with hearburn who are taking Nexium and other meds and still can't get relief."

What's scary is that many of the people who find out they have Barrett's and EC have minimal pain until they have difficulty swallowing and then go to a doctor. In fact the presence of Barrett's usually decreases the pain. What a deceitful trick to play.

I guess we all have to learn not to wallow in our past. Hindsight is always 20/20.

[cpadpl]

daw

I don't mean to pry, but what exactly is your condition? Are you saying you had no symptoms, and then found out you had Barrett's? When you say stress, do you mean GERD induced by stress?

I had a brief period between Zantac and Nexium (before I started really seeing a doctor) where I basically got p-od and tried to go off all drugs. I would get up and drink some Mylanta, then drink 2 or 3 cups of coffee, go to work (VERY stressful environment), and then get angry because I had heartburn. Maybe I just should have kicked the coffee, huh? But what I would notice is that on the weekend, I could drink the same amount of coffee and no problem. Sometimes, I could actually FEEL the heartburn "arising" as stress levels increased at work...call me crazy but I swear I could...

And as far as being hard on myself, I only blame my late-twenties (from 1995-1999) when I was 23 to 27 and I should have known better. My early twenties I can't hold myself accountable, because there really wasn't that much public knowledge (OR EVEN INTERNET!) about the damage heartburn could do. If you really think about it, pre-today's common knowledge, how many people would have mentioned "heartburn" when they went to the doctor. I don't mention occasional earwax, occasional bleeding gums, a weak right ankle that is prone to give out all of a sudden, or the fact that I get a headache probably once a week, so why would a 21 year old man mention heartburn?

This whole learning process is truly a big shock to me!

[LSAT]

cpadpl...Here is a good web site for you to read. Maybe it will help you with your anxiety over this question. http://www.barrettsinfo.com/content/2_could_i_have_barretts.htm

[The Pard]

Hi Cpadpl,

It sounds like you may have been close to knowing what to do, but old habits like coffee in the morning are hard to break. (I found that coffee
and a chocolate dipped donut was enought to plug me up until lunch time and the reflux seemed to improve after a less undigestable meal.)
Even avoiding the white plasticine-like flour of the donut improved things when I switched to the
chocolate glazed (more cakelike) variety.

Do you recall the first day that you found a mouthful of acid and didn't know what it was?
Was this after some strenuous exercise, sports,
wrestling with someone, a fall, car accident,
violent throwing up after a night of too much beer
as a teenager.. etc? Knowing when it started is
important so that you can avoid the activity
that seems to be a common trigger.

Do you have belching, burping and buring in the stomach which improves after eating, for an hour or so? If you have a white coated tongue, a sour
taste in the mouth and bad breath, and this
all began after a new girlfriend, eating strange
foods in a tropical paradise, swimming in an
unknown lake or river, where pollution testing
is unknown, then a blood test for Helicobacter Pylori might be worthwhile.

Let me know if any of this makes sense and I will
paste some appropriate links.

The Pard

[Hawk]

Wow... Coffee and a chocolate dipped donut... That's enough to get you into the Reflux Hall of Fame.... :eek:

[daw]

cpadpl asked "Are you saying you had no symptoms, and then found out you had Barrett's? When you say stress, do you mean GERD induced by stress?"

Here's the short version:
Well I am 56 years old. I never had any heartburn until I was 54. After 9 months of mild to moderate heartburn and a short trial of Prevacid my GP sent me to a GI who did an endoscopy and found esophagitis and a minute focus of intestinal metaplasia. The diagnosis was short (0.5cm) segment Barrett's.

I had some dealings with anxiety and panic attacks in my younger years and at the time of diagnosis I was 8 years into a very stressful job. I quit my job (I like to call it a semi retirement) took my meds (Pepcid, Nexium and Xanax) and watched what I ate. My one year endoscopy showed no intestinal metaplasia on 6 biopsies. So at least it isn't getting worse and maybe even getting better (knock on the computer desk).

Whether I actually had "silent" GERD all my years of stress and anxiety I'll never know. I do believe the connection of anxiety induced bile reflux but I may never know if that too was my problem.

[cpadpl]

You crack me up, "this all began after a new girlfriend"...I lot of bad things happened after new girlfriends, in fact, I'd like to attribute 1) my previous need to drink alcohol and 2) any other physical or mental malady I've had to a girlfriend....hehehe...Seriously, thanks so much for the info. I'm sorry if I'm asking elementary questions, but as I said, this is all a big shock for me and I'm trying to absorb it all. I just started looking into this stuff after my GP informed me I need to go so a GI doctor. "Hell, I thought this Nexium stuff just went on happily ever after...", I said. He said, "Well it can go on forever, but we need to find out why you need the Nexium in the first place and you need to see a GI for that.." DOH!

To answer your questions, I've never had a mouthful of acid. I started having typical breastbone heartburn around the ages of 17-19. It is during this time that I started doing typically stupid things. My mornings in highschool consisted of sticking a large cup of water in the microwave for 4 minutes (to get super boiling) then place 6 heaping teaspons of instant coffee, 12 teaspoons of creamer, and 12 more teaspoons of sugar into the mug, downing it, spending about 15 minutes on the toilet in a little discomfort, and then heading off to school. Seriously, I only did this 1) because I was partying and only getting maybe 4 hours of sleep a night and 2) they were very strict on bathroom breaks so I couldn't drink 6 whole cups of liquid coffee, I had to condense them....

My early 20s consistented of your typical smoking and drinking alcohol, drinking pots of coffee to cram for tests, etc...This is when the hearburn got to where it was happening more often when I was where somewhere I couldn't get a Tums. That's when I moved to Tagamet just so I didn't have to worry about always having Tums (especially when your on a date at 1:00 am).

My mid 20s (24 - on) consisted of me entering the workforce, dropping smoking completely, lowering my alcohol consumption, but increasing my intake of coffee, softdrinks, and stress....This is when I moved to Zantac because i heard it was safer than Tagamet and it took care of me for 12 hours at a time....I also started to limit my intake of coffee and softdrinks as I found I was getting up to the 4 a day (OTC) limit on Tagament before moving to Zantac.

My late 20s consisted of me doing great on OTC Zantac. Then, I started to stop my food limit again the Zantac worked so well (and the stress started to get to me). I started back to 2-3 cups of coffee a day, sometimes drinking as many as 8 or 9 softdrinks a day, usually some hearty pasta for dinner along with a couple beers....Towards the very end 2 OTC Zantac's a day weren't carrying me sometimes and I would have to take a 3rd.

The last two years of my 20s (late 28 and 29) consisted of me being placed on Nexium in which case I went HOG wild (except for drinking, I quit when I was 27). I found that I could never overpower the Nexium, even on high stress days I drank coffee all day, softdrinks too, and finished the night off with a late dinner...Then the doctor told me it was GI doctor time, then I realized this wasn't a game and I wasn't getting off scott-free with a little purple pill.

Thus, here I am, just about to turn 30. I proactively got my doctor to move me from the 40mg Nexiums to the 20mg ones (I read websites of some people successfully doing that, called the "step down"). I am doing great on those. I no longer drink coffee or softdrinks (note I was doing great on the 20mg BEFORE I got rid of the coffee and softdrinks). I also do not eat anything 3 hours before dinner.

Regarding the characteristics you pointed out, I have NO white tongue, sour taste, bad breath, and have tested negative for Hpylori (first test my GP gave me). I do and have ALWAYS belched on full and empty stomach (I don't know why). My type of heartburn seems to follow my hunger and stress level, and therefore is not exclusively at nighttime. The burning does feel much better after eating.

Sorry for the long post, but I wanted to give you everything you requested.

[The Pard]

Hi Cpadpl..

Is that an accronym for some activity that can't be done in a canoe? :-?

The belching an burping and feeling better after you eat can be the only symptom of helicobacter.
Only 80% of the infections show up in a blood test for "Pylori" The remaining strains are
comprised of over 20 other types that do not show
up. Sometimes a doctor has to fly by the seat of his pants and say "lets try the week of antibiotics and see if it helps"

You won't get this type of treatment from a GP without a lot of past success in this approach.
Sometimes an infectious disease doctor is
a better choice.

http://www.drmirkin.com/archive/6990.html
http://www.drmirkin.com/archive/7242.html
http://www.drmirkin.com/morehealth/1401.html
http://www.drmirkin.com/morehealth/g122.htm

Good luck..
The Pard

[cpadpl]

Pard,

This is all very interesting. I hope that my GI doctor knows more about this stuff than my GP (who is an Infectious Disease doctor, but specializes in blood diseases).

I guess my question is what are differing symptoms of GERD and helicobacter? For instance, some of worst heartburn would be during the day before I got hungry. It seemed to preceed my hunger. After I ate, I would be fine for some time until I started to get hungry again. At nighttime, my heartburn wasn't right after I ate, but more along the lines of at 3:00 am (usually on the dot)...

Also, I guess I'm confused the more I read. I now see heartburn described as a "burning sensation behind the breastbone" that can last for hours or right after you recline from a meal. I never have had a constant burning sensation. Mine shoots up for a split second giving me my sharp pain that lasts very briefly. During the day, this would often co-incide with burping (but not always), and would increase as I got hungrier and hungrier. As for the nighttime, I can't tell whether I burp or not when I'm asleep.



Originally posted by The Pard
Hi Cpadpl..

Is that an accronym for some activity that can't be done in a canoe? :-?

The belching an burping and feeling better after you eat can be the only symptom of helicobacter.
Only 80% of the infections show up in a blood test for "Pylori" The remaining strains are
comprised of over 20 other types that do not show
up. Sometimes a doctor has to fly by the seat of his pants and say "lets try the week of antibiotics and see if it helps"

You won't get this type of treatment from a GP without a lot of past success in this approach.
Sometimes an infectious disease doctor is
a better choice.

http://www.drmirkin.com/archive/6990.html
http://www.drmirkin.com/archive/7242.html
http://www.drmirkin.com/morehealth/1401.html
http://www.drmirkin.com/morehealth/g122.htm

Good luck..
The Pard

[The Pard]

Hi Cpadpl,

I suspect that your GI will want to do what most other GIs do. It is safer for him that way.

An empty stomach which burns can seem like hunger pangs, but it can be stoamch acid contacting an
ulcer which causes the pain.

Pain at 3:00 AM can be due to bile being allowed into the stomach and stomach acid being called into action to correct the PH.
Again, an ulcer may be what is causing the pain.
If it is an ulcer, helicobacter is likely the cause and the same therapy as for helicobacter
applies.

Go to drmirkin.com and search "helicobacter"

The Pard