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Differences between esophagram and endoscopy

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Posted 12/13/2017 10:11 PM (GMT 0)
I've had GERD for a little over 6 years now. Mostly managed with medicine, but lately it's been rearing its ugliness and I'm sick of taking medicine so I'm investigating the surgery option.

The GI PA had me go get an endoscopy and to have this Bravo monitoring device put in. They were unable to put the Bravo device in (report said "due to resistance" and "This can be seen in patients with occult Zenker's diverticulum"). Other than that, the endoscopy came back without anything alarming (Report said: "Gastroesophageal reflux disease without esophagitis").

So, I had an esophagram (barium swallow) to see if there was a Zenker's diverticulum. They didn't see one. But they noted "Minor irregularities of the distal esophagus near the GE junction, could be superficial ulcerations, other etiologies are also possible."

I just talked to the PA and she said that there was nothing to follow up on because they didn't see something on the endoscopy. But a quick google search (which I probably shouldn't have done) makes me think otherwise.

I have a very robust history of cancer in my family. Mother (3 cancers), Father (2 cancers), Little Brother (Leukemia), Older Brother (3 separate myelomas, and they're still looking for more).

Should I be worried? Should I insist on a biopsy of the area?

Thank you for any input!
Posted 12/13/2017 10:20 PM (GMT 0)
Did you mention your family history of cancer to your doctor?
Posted 12/13/2017 10:29 PM (GMT 0)
That is an excellent question. I am sure it is in my chart, but as soon as you asked, I realized that it's possible I never discussed that explicitly with the GI PA. I will do that. Thank you.
Posted 12/14/2017 12:55 PM (GMT 0)
DoubleChecking:

I understand your concern with your family history, but the endoscopy showed nothing remarkable. You don't have Barrett's Esophagus, and even with that the chances of it evolving into cancer are very slim. If your symptoms are mostly managed with medicine and potentially lifestyle changes, including diet, I would be tempted to ask your doctor about weaning yourself off of PPIs and see if you can manage with medications such as Zantac and Pepcid. Two things, do yourself a favor and don't use Dr. Google, it's rarely ever correct and you will end up stressing yourself out more. I view surgery as a last option, it's major and the recovery is difficult. The surgeon's don't do a good enough job of explaining what you will experience post-operatively. I suffered with GERD, large hernia and asthma symptoms for most of my adult life (I had surgery at 53), had a full wrap and hernia repair. I no longer belch, and lost the ability to vomit, which is very common. The NF left me weak, and exhausted and I missed two months of work. One of the other tests that is absolutely necessary prior to considering surgery is the manomotry which tests swallowing function, which is will determine if you are even a candidate.

Sharon
Posted 12/14/2017 7:39 PM (GMT 0)
Thank you for the response. Especially the part about the surgery. I'll have to look into that more.

I agree that the chances are small that there's something cancerous. But a few things that concern me and that, from my perspective at least, warrant at least looking further into this:
- From what I've read, endoscopies are not overly successful at catching early esophageal cancers. But they're great at seeing cancers that have progressed further.
- Something DID show up on the esophagram (which could end up being nothing, but combined with the first bit, gives me pause)
- Barrett's Esophagus greatly increases your chances of developing cancer, but it's completely possible to develop esophageal cancer without ever having Barrett's Esophagus.

I know I'm freaking myself out by reading up on this. But considering my family history, I usually err on the side of being overcautious.
Posted 12/14/2017 9:05 PM (GMT 0)
Apparently, the doctor didn't feel the need to biopsy. Why not get a 2nd opinion, have another doctor look at your test results. Again, please stop Googling!
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