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Barrett's and protection

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Posted 12/5/2011 10:53 PM (GMT 0)
When you read about Barrett's it's a pre-cancer stadium as the lining is different from normal but more protective.

After reading some articles it says the new scared lining called Barrett's got a similar lining that is inside the stomach to protect it better against the acid.

about 5-10% develops cancer but mostly most people will die a natural death before it even develops to cancer.

My question would be, if a patient develops Barrett's, are the GERD symtoms still present like soar throat, burning etc? if the lining is different and more protective with Barrett's the symtoms should go away you would think?

Is there any real need for medication with PPIs or H2s when a patient already have Barrett's? the damage is already done and few patients i read go back to healthy lining again, the metaplasia is still there in most cases despite PPIs in what i've read.
Posted 12/6/2011 1:18 AM (GMT 0)
Good Evening,

Good question but one I do not have an answer to nor could I find one searching for you on the net.  I would suspect a Dr. dealing in esophgeal cancer would have some input for you.

Take care,

Kitt

Posted 12/6/2011 9:34 AM (GMT 0)
Lanab,

If it were me (and I do have a teeny tiny area of Barretts - it's common to find a tiny bit near the junction, probably a lot of people don't know they have it!!).... anyway, if it were me I would be worried about the Barretts getting worse. If I had zero symptoms off drugs then I'd go with occasional monitoring and a fingers crossed approach - the incidence of transformation from Barretts to adenocarcinoma is now put at around 1% (there was a thread on this not so long ago). The incidence has become so low, and the association now so tenuous that the researchers are basically saying "So if Barretts doesn't cause adenocarcinoma very often, then we need to look elsewhere to find out what does!".

So really we need to stop associating Barretts with cancer - there just isn't the evidence any more.
(see http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/)

Reasons to continue medication, if you already had Barretts would be: -

* symptom control (GERD is just no fun as we all know)
* fear of being in the 1% who do get the cancerous changes
* to keep it under control until you could have ablation treatment
* to prevent any possible complications of Barretts oesophagus such as oesophageal ulcers or difficulty swallowing

I don't think the presence of Barretts means you have less awareness or less symptomatology associated with your GERD - I would guess if that were true then there would be a lot more people with undetected Barretts in its advanced stages and the association with cancerous changes would be a lot stronger.

This article says hiatus hernia is very strongly associated with Barretts - and hernia is something that can give people a lot of symptoms, so again I would guess you can't develop Barretts and then have some degree of "resistance" or unawareness of acid reflux. Barretts isn't going to get there on its own without some other GERD type issues, I reckon.
http://www.ncbi.nlm.nih.gov/pubmed/19097360

Hope that helps!

MMM
Posted 12/6/2011 9:45 AM (GMT 0)
https://www.healingwell.com/community/default.aspx?f=45&m=2243762

Here's the link to the more recent (and favourable) research on Barretts).

MMM
Posted 12/6/2011 1:19 PM (GMT 0)
Thanks Mugmagnetmum!

I do remember once reading that if you notice less symptoms after years of GERD, it could mean Barrett's since w/ Barrett's you are more protected and feel it less. Honestly, you can find anything online...and this wasn't a journal study or anything, just a regular webpage. It was the only time I ever saw anything like it.
Posted 12/6/2011 2:12 PM (GMT 0)
You're welcome ARM. And you might like this finding too.....


http://www.sciencedirect.com/science/article/pii/S0016508502001245

A 2002 study side tracked 110 patients who were going to have a sigmoidoscopy for bowel cancer screening - and gave them all a free endoscopy. These patients were all asymptomatic (symptom free as far as GERD or Barretts goes). This is what they found: -

* 27 people had intestinal metaplasia (tissue that has transformed from normal oesophagus to stomach type tissue)
* 8 had long segment Barretts (coming higher up than short segment!)
* 19 had short segment Barretts (low down near to the junction or hernia)

They reported a coincidental finding of Barretts (i.e. you weren't looking for it because there were no symptoms) at a rate of about 25%. So 25% of their study group had Barretts oesophagus but had no symptoms of GERD (the people in their study were mostly white males over 50 years of age, so some skewing of selection there). They found that the people who DID have Barretts were no more likely to be smokers, alcoholics, overweight or have a family history of GERD.

So based on that it could well be that their findings extend to the general populus in the Western world - meaning around 25% of men over the age of 50 will have Barretts and not know about it.

Having read a bit further it is possible to have Barretts without symptoms and a sliding hernia without symptoms, especially if you are the "target market" (men in their 60s)! But given that acid reflux is thought to be the predominant cause of Barretts, I would guess that you are more likely than not to have symptoms of GERD alongside your Barretts.

Going back to Lanab's question (would the symptoms go away if you developed Barretts) is probably impossible to answer as anyone with symptoms is going to have an endoscopy and get given ppis for their symptoms. I'll have another dig around if I get time again later!

MMM
Posted 12/6/2011 5:05 PM (GMT 0)
I also wanted to point out that the interaction of fluids and tissue is likely not as clearcut as that.

So, even if you have some part of the tissue with barretts (and presumably protecting the tissue from the acid) - that does not mean that you will be completely asymptomatic since there could be other parts of the organ where the acid can go where the barretts has not advanced yet and therefore still give you symptoms.
Posted 12/6/2011 5:17 PM (GMT 0)

mudmagnetmum said...
You're welcome ARM. And you might like this finding too.....



Going back to Lanab's question (would the symptoms go away if you developed Barretts) is probably impossible to answer as anyone with symptoms is going to have an endoscopy and get given ppis for their symptoms. I'll have another dig around if I get time again later!

MMM

Which in the end patients with Barrett's can skip PPIs if they do not have terrible symtoms as cancer will never develop anyway during their life, maybe doctors are overprotecting this issue?

Our body is smarter than most doctors beleive, Barrett's being one of the new linings being created to protect the body from more acid harm.

I will agree that some patients get problems swallowing where the muscle doesn't work as it should and food gets stucked, but getting Barrett's can't be that bad as the articles say and the probability to develop cancer is so low
Posted 12/6/2011 5:53 PM (GMT 0)
Glad to see the MMM had some links for you - what a wise person !

Looks like you had other memebers step up and give you good advice also.

Keep posting with us.

Kitt

Posted 12/6/2011 6:47 PM (GMT 0)
You can also ablate the Barrets using http://www.barrx.com/ and get rid of it

Edopter
Posted 12/6/2011 7:35 PM (GMT 0)
Yes this is a great forum for information, thanks to all.

I am doing my endoscopy next week at last, been 20 years since i did it last time.
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