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Only 10-15% of GERD sufferers develop Barretts?

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Posted 10/2/2011 9:18 PM (GMT 0)
As I push for surgery, I have read that oftentimes surgery is not a complete cure, brings other problems, and may require the same medication post-operation anyway...

So I have been thinking...my Dr. has told me only 10-15% of GERD sufferers develop Barretts. I used to think that most GERD sufferers took medication and were asymptomatic thereafter, and that I was a special case that medication wasn't working for (and thus more likely to develop Barrett's). However, it now seems to me a LOT of people are struggling on medications.

So my question is: Does someone like me, suffering symptoms daily and especially at night, still have only a 15% chance of developing Barrett's?

I know this is a tough question to answer, but I hope my point is getting across here and that maybe some generalizations can be made. If I, at age 28 and a chronic GERD sufferer for 3+ years (living w/ symptoms almost daily), can live my life this way with these symptoms and only have a 15% of getting Barretts, it seems to me it would be better to live with the pain and try to avoid surgery and its concomitant risks, complications and limitations.

Does that make sense? If you can live with the bad quality of life aspect by reminding yourself that the risk for Barrett's is only 15%, regardless of how bad it looks day to day....I'd probably prefer to live that way and live my life instead of getting the surgery.

Still, have my date w/ a surgeon this week to gather info and see how suitable I am. Just kicking around ideas for now :) Thanks as always to everyone for the continued help and support.
Posted 10/2/2011 11:26 PM (GMT 0)
To the best of my knowledge a Nissen does not prevent Barretts.

As surgery is invasive as well as expensive, one would ask if this is indeed the best alternative there is for people suffering from acid reflux. There are varying options on the matter and a continuing debate rage among those who believe that surgery is indeed the answer and those who think that it is not.

In your case you must make an informed decision whether or not to have the surgery based on your own case history.  Only you can decide if you are willing to tolerate living a less then optimal quality of life .

Good luck at your Drs. appointment.

 

Posted 10/2/2011 11:41 PM (GMT 0)
But surgery can prevent reflux, and thus getting Barrett's if you don't have it yet, right? My whole question is if you don't have Barrett's and odd's of getting it are 10-15% (according to my Dr.), then is surgery the best option regardless...

Yet from what I gather on the forum more than 15% of people here have Barrett's...it seems much more like 50%+
Posted 10/3/2011 12:45 AM (GMT 0)
theacidrefluxman

i think you are asking questions that their is not yet and answer for, given the current state of medical science

i may well be wrong...but

to my knowledge there is no study yet proving that doing one thing or another,,,meds,... surgery,... or what ever... that lowsers risk of barretts once one has been diagnosed with GERD

i dont even know if radio frequency ablation of barretts , lowers risk for subsequent barretts??

i may well be wrong abut this...just saying i have yet to read such a study.

that doesnt mean that some of these strategies wont lower your risk...just that the proof isnt there yet??

it makes sense to me that decreasing the amount of acid that gets above the LES has got to be a good thing

i dont know how one would decide , what you have to decide...im guessing maybe quality of life?... how you feel physically?... and mentally ??? ,,,emotional health is very important!!!

good luck as you weigh your choices

best wishes
mick turtle
Posted 10/3/2011 12:56 AM (GMT 0)
thanks mock turtle. I can always count on your honest opinions even (and usually) when I am asking the un-answerable, which I frequently do :) Hope all is well with you, I really enjoy having you on the forum ;)
Posted 10/3/2011 2:22 AM (GMT 0)
ARM-
You said "Does that make sense? If you can live with the bad quality of life aspect by reminding yourself that the risk for Barrett's is only 15%, regardless of how bad it looks day to day....I'd probably prefer to live that way and live my life instead of getting the surgery."

I was not willing to live the rest of my life taking high doses of PPIs or dealing with the pain every day and night. My LES wasn't staying closed and the only viable option to have quality of life without the pain was surgery. And yes the surgery makes a functioning LES and that's what keeps the acid and bile and what ever else is in the stomach down where it belongs, thus lack of acid in the esophagus stops the cells from changing to stomach cells. That is what is happening when someone gets barretts. The lining cells are actually being changed to stomach cells to try and protect it's self from the acid. And when cells change that's how cancer begins.

If I would have been more informed when I was 28 I would have asked for the surgery then. I was so tired of dealing with the pain and taking meds for reflux and having to remember when to take them and the cost of the meds I was going to ask about the surgery at a GI appointment and before I could ask the doctor told me my only option to stop the reflux was surgery because my LES wasn't closing. I was 35 when I finally had surgery. I wish I had pushed for the ph study and manometry a few years sooner, but I wasn't aware of a surgical repair until I was 35 and had done more research into treatments for this.

Before this they just kept changing dosage and types of PPIs and I was up to 4 PPIs (max dose of prevacid 4 times a day)a day when I finally got the tests done to see why they weren't working. My surgeons have asked me all 3 times what I would rather have, Taking high doses of PPIs the rest of my life and deal with their side effects and the cost or try the surgery and in the best scenario be symptom free and in the worst case scenario have some of the negative issues and possibly have to still take PPIs but at a way lower dose? If you have all the tests done and find a good surgeon and he/she feels you are a good candidate to have minimum to no issues after surgery, after the recovery you should be good to go.

Some people say you can't have the nissen reversed, but there are surgeons who will reverse it if you have issues that are worse than dealing with the reflux or may have a better technique. My surgeon who did my first redo does reverse them when it's needed. He asked me right before going into the OR if he didn't find anything wrong if I wanted to keep the nissen as it is, reverse it, or redo it using his technique and see if it's better.

I believe the 15% is probably about right for overall. I believe we have a higher percentage here because we have core pf people who are having severe reflux and that is why they have found their way here. Does that make any sense to you?

I forget what tests you have had done. Have you had a ph study and a manometry done yet? Those are probably the 2 tests I that should be done before surgery was even thought about. None of my surgeons would do it until I had at least these 2 tests done already. The manometry is very important because it shows how the esophagus is functioning. That tells the surgeon whether you are able to have the surgery at all or if a modified nissen would be best.

Take care,
Bill
Posted 10/3/2011 2:55 AM (GMT 0)
theacidrefluxman

thanks for the kind words

hey i looked so more and found this

this article does not exactly speak to the issue you raised but its as close as i could come

you wanted to know about fundoplication decreasing risk for barretts right?

well how about a study that looks at people with barretts already, who then get fundoplication and what happens to their baretts after the surgery!!

seems to me if people saw their barrets regress or even go away after fundoplication, then that would suggest that those without barretts who get fundo should see a decreased risk for ever getting barretts, right? i mean that sems to make sense

so here it is

this study shows that 18 percent of those with BE who got fundoplication saw their barretts go away two years or so later !!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122088/

( an another 9% saw the length of their BE get shorter)

best wishes
mock turtle


ps but then again this article questions whether or not fundoplication is a cancer preventative

http://www.nature.com/ajg/journal/v100/n5/full/ajg2005173a.html

so i dont know what to think...well... i gotta go with the first article, cause acid belongs in the stomach

Post Edited (mock turtle) : 10/2/2011 9:12:29 PM (GMT-6)

Posted 10/3/2011 3:19 PM (GMT 0)
What concerns me is that the rate of esophageal cancer has skyrocketed since the widespread use of PPIs. I dont trust them. It seems like the Nissen would be a good way to reduce your chances, but like others have said, its not been proven. Some recent research has indicated that Barretts starts at the esophageal junction with the stomach, and I dont know if the Nissen stops acid from getting there or not. Im not even sure if its the acid that causes Barretts. Dr. Koufman's reseach seems to point to Pepsin being much more damaging to tissue. And I have read on this message board that PPIs greatly increase the amount of Pepsin in your stomach. The whole thing is very confusing.
Posted 10/3/2011 5:51 PM (GMT 0)
yes the rate of esoph cancer has gone up fast

and yes this has happened while PPIs use has gone way up

but other things are happening too

id be willing to blame PPIs and have suspected them as problematic

but

we need to have hard evidence and be sure...PPIs may not be the problem

other things have been happening since PPIs use became wide spread

more fast food, more prepared food in the markets, more chemical preservatives, and chemicals in the environment

and...heres a big one

more obesity

so while i suspect PPIs as potentially being a problem...just the same , i dont know an have to keep looking for research to , hopefully explain why esophageal cancer is the fastest rising cancer in the western world

i share your concerns

best wishes
mock turtle
Posted 10/3/2011 7:03 PM (GMT 0)
wait...ppi's may cause esophageal cancer? I do better off them than on them, but try to be on them to keep acid out of my reflux...explain more please :) this seems important to know. Where did you all get the idea from?
Posted 10/3/2011 7:38 PM (GMT 0)
Im not saying that they cause esophageal cancer. Just that cancer rates have gone up ... a lot... since their widespread use. But like Mock T said, there could be a variety of explanations for this. As far as pepsin goes, you can google Dr. Koufman's research on its affects. I will say that the worst that my LPR ever was was when i was taking 1 ppi. I currently take none.
Posted 10/3/2011 7:59 PM (GMT 0)
but wouldn't ppi's help LPR in that they lower acid levels, thus making it less inhabitable in your esophagus for pepsin (not having stomach acid washed up into it through reflux)?
Posted 10/3/2011 9:00 PM (GMT 0)
Standard treatment for LPR is PPIs twice a day, because 1/day doesnt provide 24 hour acid suppression (closer to 12 hours). There is a chemical in your blood that signals your proton pumps to produce acid. Its called Gastrin. For whatever reason, PPIs cause gastrin levels to increase in your blood supply. This is why many people get acid rebound when they come off of PPIs (because the elevated Gastrin levels without the PPI to counter act the acid secretion causes tons of acid to be produced). My theory (and i stress MY theory) is that once daily ppis caused me to have elevated Gastrin levels and only partial day suppression, thus leaving part of the day with no PPI help and elevated gastrin and thus making my LPR worse. When I got on 60mg of dexilan (the equivalent of twice daily PPIs) i did much better. Unfortunately after about 7 months on Dexilant i started developing severe lower abdominal pains. I am off all PPIs to see if that helps. So far it isnt helping too much. I suspect the PPIs as the cause of my lower abdominal pain (via some sort of bacterial overgrowth or something) but cant prove it. I am undergoing a seried of tests to rule out anything serous like IBD. I know of at least one other member who developed lower abdominal problems after starting PPIs.
Posted 10/3/2011 10:02 PM (GMT 0)
so I may be better off of PPI's than on? yet all dr's do is give you PPI's...wish there were more knowledge in this area of medicine.
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