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Barretts Esophagus, squamous epithelium shows changes of reflux oesophagitis, constant burping and bloating, no Helicobacter infection, no intertinal metaplasia, no dysplasia or malignancy

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Barretts Esophagus
I am currently aged 30, male, Asian, non-smoker and have been suffering from constant burping and bloating since 2007. I have had two upper endoscopies; once in Nov'08 and the 2nd a few weeks ago - Mar'12.

A few days ago the biopsy result from the 2nd endoscopy came back with the following:
"Oesophagus: Sections show squamo-columnar junction, including columnar mucosa of gastric cardiac and fundic types. There is intestinal metaplasia, consistent with a clinical diagnosis of Barrett's oesophagus. A mild chornic inflammatory cell infiltrate is present in the lamina propria together with focal activity. There is no evidence of dysplasia or malignancy. No ulceration is identified. The squamous epithelium shows changes of reflux oesophagitis.

After I awoke from the procedure, the Gastroenterologist stated that my overall condition was better than what he saw during my last endoscopy back in Nov'08 which showed "Eroded, inflamed gastro-oesophageal junction, with no Helicobacter infection, intertinal metaplasia, dysplasia or malignancy". It wasn't until my GP informed me of my biopsy results that I got the surprise of my life - that I have BE. No further information were given other than telling me to go and see my Gastroenterologist, with the earliest appoint. in another months time.

My GP had prescribed Somac (Pantoprazole) and Tazac (Nizatidine) after my 1st endoscopy, but it wasn't until XXXXXXX of this year 2012, that I started taking the medication on a daily basis.

My questions for you today are the following:
1) How could there be such discrepancy between what the Gastroenterlogist saw and what the biopsy showed.
2) Even with medication and dietary changes, how quickly can the BE progress.
3) Other than the wait-and-see approach, what other pro-active measures can I take to get rid of BE.
4) For the past week, I seem to be getting throat constriction / lump sensations and a bit of hoarse voice. Are these anxiety related or complications from BE/GERD?
Posted Tue, 22 May 2012 in GERD
Answered by Dr. Poorna Chandra K.S 37 hours later
Hi and thanks for the query
Reflux esophagitis and barrets esophagus are a continium of the pathology associated with gastroesophageal reflux disease. Repeated injury secondary to reflux causes a change in the type of the lining epithelium to the intestinal type of columnar epithelium, as it can stand acid better. This change occurs over years of uncontrolled reflux
At the gastroesophageal junction the change to barret's mucosa may be patchy and missed sometimes on a random biopsy. Visualisation in the routine white light endoscopy may not clearly show the Barret's mucosa and hence the endoscopist may not target the lesion and the biopsy report will not show Barret's mucosa. Now a days there are new endoscopes with special imaging which highlights the Barret's mucosa and allows for accurate targeting the biopsy. These are the reasons for the stated discrepencies and the apparent rapind progression.
The symptoms that you have stated can occur with reflux but can also be worsened by your anxiety.
Barret's develops it is usually not reversible however it can be prevented from progressing further into barret's with dysplasia by avoiding further reflux. Take a twice a day dose of proton pump inhibitor along with a prokinetic and adopt some lifestyle changes like - not lying down for 2 hrs after meals, repeated small meals rather than a large meal. head end elvation while lying down,breathing or diaphragmatic exercises and loosing some weight.
Hope this answers your query
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