Free Medical Advice Related to Laparoscopic Surgery

Barrets Oesophagus
Discussion in 'All Categories' started by Ninja - May 2nd, 2013 8:49 pm.
Ninja
Ninja
I have recently been diagnosed with Barret's oesophagus. I had previoulsy given treatment after complainign about GERD. The treatement was to eradicate H. Pylori. the intical treatment failed. During the endscopy to see eradication of H. pylori, biopsies were taken. Histopathology report says the following:

Patient Ninja
Date of birth: 1 December 1969

Material Received: 16/04/2013
Report done: 18.4.2013

Information and clinical diagnosis:

A. Duodenum sp B. Hp gastritis. C esophagogastric junction

Grossing:

N 130671A 2 FGTS. Included in toto
N130671B: 5 FGTS. Included in toto
N 130671C 4 FGTS. Included in toto

microscopy:

N 130671A: Fragments of tangential doudenal mucosa without inflammation or atrophy of villi or giardiasis.

N 130671B: Fragments of the gastric mucosa, fundic and antral, showing both a superficial chronic inflammatory infiltrate with no activity. The special color highlights evidence of Helicobacter in small quantities. No intestinal metaplasia. No atrophy or dysplasia.

N 130671C: Fragments of gastro-esophageal gastric mucosa with signs of chronic inflammation and micro cysts. At the transition of two mucosal presence of a small focus intestinal metaplasia without dysplasia.

Diagnostic Anatomical Pathology;

- Without duodenal mucosal lesion.

- Chronic superficial gastritis has helocobacters pylori.

- Barrett's esophagus without dysplasia.

Endoscopy report says the following:

Upper gastrointestinal duodenoscopy of 15.04.2013

Premedication: Local Anesthesia. Good cooperation. Camera: Video gastroscope Pentax EG-2940K.

Indications: This patient reported frequent belching, epigastric pain and heartburn. He took a treatment to eradicate Helicobacter pylori in the month of March 2013, following a positive breath test. Eventually the symptoms have persisted, despite taking omeprazole.

Review:

Esophagus: the esophageal mucosa was normal up to 40 cm of the upper dental arch, and at the junction of the mucous membranes and the hiatus. Five biopsies are performed, in search of intestinal metaplasia.

Stomach: The stomach mucosa is erythematous irregularly. Lots of gastric biopsies are performed. The pylorus is smooth and symmetrical.

Bulb and duodenum: bulbo-duodenal mucosa without particularity until D2. Two duodenal biopsies are performed.

Conclusions chronic gastritis, otherwise examination within the norm.

Proposals: I look for histology whether the antibiotic was effective salary:. Surprised by presistance of symptoms despite treatment with omeprazole, I suggested the patient to avoid dairy products. It seems much better since.

What can I do. Need your advice

should I go for RFA. or any other procedure.

My present symptoms include - continous heartburn despite taking 40 esomeprazole twide daily.

Thanks for your attenstion and help and advice.
re: Barrets Oesophagus by Dr J S Chowhan - May 2nd, 2013 9:04 pm
#1
Dr J S Chowhan
Dr J S Chowhan
Dear Ninja

As you have Barretts esophagus but do not have dysplasia. We recommend that if the past two endoscopy and biopsy examinations have confirmed the absence of dysplasia, then you should have another endoscopy after three years. Careful watch is required. Laser treatment or RFA is used in severe dysplasia, while overt malignancy may require surgery, radiation therapy, or systemic chemotherapy but at present you are far away from these conditions.

Proton pump inhibitor drugs should be taken by you to prevent further progress. Additionally photodynamic therapy using photofrin is statistically has been found in patient with barrets oesophagus more effective in eliminating dysplastic growth areas than sole use of a proton pump inhibitor.

After consulting your physician you can also go for Nissen fundoplication can reduce the reflux of acid from the stomach into the esophagus.

Taking low dose of aspirin, have shown evidence of preventing esophageal cancer in Barrett esophagus in few study.

The treatment strategy also depends upon your life style and few changes in that is also require so please discuss all these possibilities with your gastroenterologist and get the proper treatment according to his advice.

With regards

J S Chowhan
re: Barrets Oesophagus by Daniul - May 22nd, 2013 3:05 am
#2
Daniul
Daniul
Dear Sir,

I sincerely tbank you for your kind advices.

I should like to seek your kind advice on the followings:

A. Intestinal Metaplasia: I have checked with some doctors here and some of them opined that taking biopsies from Gatro esophageal junction in normally looking esophagues during endoscopy is not indicated (my endoscopy report indicate that the esophagus was normal looking). and inestinal metaplasia at this area (transitional zone between two mucosa types) does not qualify for Barret's. In such a situation what should I do? Is it inestinal metaplasia in the cardia?
since I have chronic gastrities_ do you think the intestinal metaplasia is due to the H. pylori induced chornic gastrities? And also do you think I can take low dose (can you suggest the dose also please) Aspirin in this condition with PPI.

Also, do you think I can go for genetic test such as P53 aneuplody etc.
I have so far done only one endoscopy about one month ago. Should I do it immediately now to cornfirm the diagnosis?

B. GERD: I have ongoing GERD. I have burping imediately after meal (continous). Previously I used to have high chest burn. Now it is there but with less intensitiy ( I am taking esomeprazole 20 mg b.d). After taking any food
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