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Patients with esophagitis (grade A) while on nexium 40mg bid

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Posted 5/21/2014 1:35 PM (GMT 0)
Hello, I am a patient with Esophagitis (grade A) while on nexium 40mg twice daily. My doctor confirmed a "gaping LES) during my endoscopy.

My doctor is very anti-surgery.

I'm worried that allowing this esophagitis continue will lead to cancer.

What is the recommended treatment for patients who continue to have esophagitis while on high-dosage PPI's? Btw, I've tried every PPI.

Stephen
Posted 5/21/2014 1:52 PM (GMT 0)
Hi pharcyder, i dont know why your doctor is anti surgery but i would look into surgery if i was in your situation.
Esophagitis is very uncomfortable to live with and also ppis are not helping you. What about trying another doctor for another opinion? Ive had grade b esophagitis and was very ill . Barry
Posted 5/21/2014 2:39 PM (GMT 0)
Have you also implemented lifestyle and diet changes? Those with PPIs can be much more effective than just relying on PPIs alone.

If you have exhausted all the options though, it is looking like surgery might be indicated (and worth getting a second opinion). Do you know if you have a hiatal hernia as well? Has your doctor explained why exactly s/he is so anti-surgery?

I was on 60 mg Nexium twice daily and up to 60 mg domperidone daily, with esophagitis grade C (and Barrett's, large hiatal hernia, Cameron lesions, gastritis, esophageal rings). Because there was no improvement despite PPI and domperidone usage, I ended up having surgery at my doctor's recommendation.
Posted 5/21/2014 4:32 PM (GMT 0)
Hello Altair,
I am 5'6" 135 pounds. I eat lots of vegetables, and grill chicken / streak often. I eat cheerios for breakfast. I never touch canned or bottled food. NO catchup, Mayo, Salad dressing, etc. I eat no chocolate and no caffeine. I also sleep on a bed wedge, which basically means I sleep at a pretty steep slope.

I have a Small Hiatal Hernia.

My doctor said he is anti surgery because although I still have esophagitis, I am extremely unlikely to progress to cancer. He also said that because of my age (27), the nissen is likely to unwrap within the next 20 years, and repeat surgeries are extremely difficult. Additionally, he stated that people who respond poorly to PPI's also tend to respond poorly to the Nissen. He was very opinionated about me not getting surgery.

Please let me know what your thoughts are.

Sincerely,
Stephen
Posted 5/21/2014 6:10 PM (GMT 0)
Is it the cancer risk that has you concerned, or are the symptoms of reflux not well controlled despite the PPIs and lifestyle modifications?

If it's the cancer risk - well, it is true that the chances of progressing to cancer are slim. A random woman is more likely to develop breast cancer than someone with GERD developing esophageal cancer. And if you're having regular scopes, if there was something going a bit wrong, it would get noticed before it gets out of control.

I'm 29, and my specialist didn't have any of those worries. If anything, I was told that being young was better for surgery since it would be I would get the most "life" out of the wrap, and it would eliminate long term dependence on medications. I was advised the wrap *might* become undone later in life, but he didn't seem especially worried that it would happen. If it happened, he said repeat surgery wouldn't be a problem. Obviously it could be a tad more involved than doing it a first time (scar tissue, adhesions, etc), but he didn't think it would be extremely difficult to redo if it came to that.
Posted 5/21/2014 6:32 PM (GMT 0)
Altair,
I am concerned of cancer, however, the data (and my doctor) suggests that it's extremely unlikely. He actually said he wouldn't advise that I get another scope until I'm age 50. He said that there are studies out there that suggest that scope monitoring does not improve a patient's life expectancy or slow/delay the progression of the disease.

I take elavil for the pain. It does help. I still get pain though, and I am considering asking for opiates to mitigate the pain. What are your thoughts?

Stephen
Posted 5/21/2014 6:43 PM (GMT 0)
Hi pharcyder,

I also have Grade A Esophagitis and I am on Nexium 40 everyday. Grade D or Barret's Esophagus is the final step before cancer. My doctor said Grade A is nothing to worry about, also he stated that there are patients using PPI's over 30 years without any serious adverse effects.
Posted 5/22/2014 7:00 AM (GMT 0)
Hello, pharcyder!
GERD is chronical condition and it impacts everyday life in very bad way as you know ....(i have grade B esophagitis, 33 yo, i have it i guess about 6 months and take PPi's - here is a link to my topic)

If you can achieve any big gastro clinic in your area i would suggest that you take the chance to talk with the good surgeon. You need to know all the options that you have not only Nissen Fundoplication! Maybe you are a candidate for less invasive surgeries like LINX or ENDOSTIM.

Just search for a good gastro-clinic.
Posted 5/22/2014 1:00 PM (GMT 0)
I would get a second opinion.

If you have a "gaping" LES and esophagitis on PPIs then there is nothing else to do really except either wait and see if it settles down, or get surgery.

Have you looked into the Linx surgery, it is less major than NF but has some good results.

The decision is about more than risk of cancer, your doctor isnt the one thats got to suffer every day with pain. Quality of life is important too.
Posted 6/24/2014 4:17 PM (GMT 0)
I'm currently awaiting a 24 hr PH Manometry test in hopes that it will indicate surgery is possible/helpful.

I can't imagine why you'd rather take opiates or strong pain killers indefinitely rather than have surgery??? And if that's what your doctor would recommend for you then I'd be looking to get a new doctor!!!
Posted 6/24/2014 5:06 PM (GMT 0)
I can share the world of my Dr. r.e. grade 1 esophagitis.

"you hit the nail on the head – the finding of grade 1 esophagitis is highly subjective, often seen in normal folks with no symptoms whatsoever, and not much of a concern in this setting. "
Posted 6/24/2014 6:16 PM (GMT 0)
Endostim isn't here in the us yet which is terrible...I know it is in Germany and they have started trials in England.....this is my question in Germany is it on the market or do us have to be okayed for a trial first?
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