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Biopsy from endoscopy (EGD) - possible results?

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Posted 6/4/2014 6:43 PM (GMT 0)
Hi everyone

Like many here, I've been lurking for a while. In August of 2013 I suddenly developed a bad case of acid reflux. Serious lifestyle changes (lost 25 pounds down to baseline weight for my height, started strength training, completely changed diet) did not help. PPIs knock it down from a raging 10 to an unpleasant 8, but basically aren't working that well. I have no desire to be on them for the rest of my life.

Finally decided to see a doctor and today I saw a Gastroenterologist. Endoscopy and colonoscopy at the same time. They showed no cancer, no Barrett's. However, here's what the specialist said. Please note - this was a procedure day for him and he was running back and forth between rooms. Also, we were in a sort of common recovery room with others within earshot. He was a very nice guy, I have no complaints.

"Okay, nothing life threatening going on. I have taken a few biopsies and you can come back after a couple of weeks and we can talk about the results, and see what we can do about the problem you're having"

This is an imperfect transcript. When he was talking, I got the distinct impression that what he saw led him to believe that he might have an answer about this but wanted to talk about it at the sit-down meeting. I asked him "Is there something you think might be going on that I can Google in the meantime?" and he sort of said "Let's wait until we meet".

So... here's my question. Does this ring any bells for anyone? Any speculation as to what a biopsy might reveal that isn't cancer, isn't to do with Barrett's, but could contribue to an explanation about the GERD? Or, any speculation about what a specialist means when he talks like this?

Another way to put it is 'What might a Gastroenterologist biopsy that's not a cancer?'

Maybe the biopsies he wants to discuss are from the colonoscopy. I realize that it's my right to ask him whatever I want but he was a friendly guy and I didn't want to push him, and if he's okay with me coming back in a few weeks for the answers, I'm fine.

Hope this question is clear. Any input would be appreciated.

Post Edited (TOrob) : 6/6/2014 11:15:38 AM (GMT-6)

Posted 6/6/2014 12:49 PM (GMT 0)
Biopsy is standard procedure during endoscopies. Barrett's isn't "life threatening", and is only definitively diagnosed via biopsy. I am not sure about esophageal cancer, although one supposes that in its initial stages it presents as Barrett's with dysplasia.

I'd say relax and wait for the results. You were told the same thing as most people post-biopsy, as far as I can imagine.
Posted 6/6/2014 5:14 PM (GMT 0)
Thanks for the response. I didn't know that Barrett's can only be diagnosed definitively via biopsy. I thought visual inspection was enough. Mainly, I was wondering what could cause GERD that is not Barrett's and that would require a biopsy to diagnose.

You're right, though. No point in spending every moment on the web searching for information when I don't have the facts.
Posted 6/7/2014 9:05 AM (GMT 0)
There are a couple of other things biopsies test for, first is helicobacter pylori infection, which can be treated with antibiotics if found. Second is Eosinophillic esophagitus which is a type of cell in the esophagus that shouldnt be there and can cause the esophagus to be inflamed by certain allergens hence making symptoms worse. Neither is dangerous but can explain the severity of symptoms.
Posted 6/7/2014 5:20 PM (GMT 0)
Excellent, just what I was looking for Andy. Thanks. I was tested for H. Pylori early on, as I suspect many of us are. That was just a blood test though. I wonder...can H.Pylori be missed by a blood test but show up on a biopsy?

I've been very lucky. This is the first time in my life that I've waited for a medical result of any kind. It certainly does make you think.

Post Edited (TOrob) : 6/7/2014 11:48:35 AM (GMT-6)

Posted 6/7/2014 6:38 PM (GMT 0)
Yes, a definitive "gold standard" diagnosis of Barrett's is done via biopsy and subsequent histology results. Visually, you can see segments that are most likely Barrett's, but a true diagnosis is if the biopsy of the suspected area demonstrates intestinal metaplasia.

The attitude of "wait until we meet" is quite common with doctors (in my experience). With my scopes, I've always asked how it went and what their initial impressions were, and usually got a vague answer along the lines of "we'll talk about it at your follow up." It's less of an indication they found something worrying, but usually that they don't want to commit to anything without the full picture. Once they have all the relevant data (histology report, and any other outstanding investigations), they'll be able to tell you what's going on. But in the meantime, you'll probably going to get your queries deferred.
Posted 6/8/2014 11:57 PM (GMT 0)
Thanks Altair.

Do you have any idea if H. Pylori can be missed on a blood test but picked up on biopsy?
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