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I'm A 34 Year Old Male. For About 8 Years,
Question: I'm a 34 year old male. For about 8 years, I've had annual EGDs for GERD. The original chief complaint was dysphagia. I currently take 40 mgpantoprazole in the morning, and 300 mg of nizatidine before bed.During the 8 years of observation, I have occasionally had diagnoses of hiatal hernias (once on a barium swallow, but not confirmed by EGD), and several times of eosinophilic esophagitis. However, the EoE is somewhat inconsistent on biopsy. My most recent EGD biopsy was negative for EoE. My specific questions concern understanding something my gastroenterologist said during the follow-up consult.
He said that "endoscopically, it looked like there was evidence of Barrett's esophagus." However, the biopsies were negative for Barrett's, and he said that the biopsies were controlling (i.e., notwithstanding the appearance on endoscope, if the biopsies were negative, it was not Barrett's.
Still, I noticed on my insurance company's app, that the entry for the date of service (date of the EGD) indicated Barrett's without dysplasia. I'm hoping someone can help me reconcile all of this information.
1) Why would the insurance company record indicate Barrett's?
2) Is it correct that the biopsy is authoritative over the endoscopic appearance in the case of Barrett's?
3) Assuming I don't have Barrett's, as the biopsy would confirm, how can I avoid developing my chronic GERD into BE? Is this a futile effort?
4) if I ever do develop BE, what is the likelihood of this turning into a fatal cancer?
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016. On that EGD, Eosinophilic Esophagitis was confirmed by biopsy.
Finally, 5) concerning the eosinophilic esophagitis, is it possible to present intermittently (appearing on some biopsies some years, and then not on others)? Without elaborating, my doctor commented that with the historical EE diagnosis, "it all makes sense", but did not express whether this was an explanation for the endoscopic appearance of BE.
He said that "endoscopically, it looked like there was evidence of Barrett's esophagus." However, the biopsies were negative for Barrett's, and he said that the biopsies were controlling (i.e., notwithstanding the appearance on endoscope, if the biopsies were negative, it was not Barrett's.
Still, I noticed on my insurance company's app, that the entry for the date of service (date of the EGD) indicated Barrett's without dysplasia. I'm hoping someone can help me reconcile all of this information.
1) Why would the insurance company record indicate Barrett's?
2) Is it correct that the biopsy is authoritative over the endoscopic appearance in the case of Barrett's?
3) Assuming I don't have Barrett's, as the biopsy would confirm, how can I avoid developing my chronic GERD into BE? Is this a futile effort?
4) if I ever do develop BE, what is the likelihood of this turning into a fatal cancer?
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016. On that EGD, Eosinophilic Esophagitis was confirmed by biopsy.
Finally, 5) concerning the eosinophilic esophagitis, is it possible to present intermittently (appearing on some biopsies some years, and then not on others)? Without elaborating, my doctor commented that with the historical EE diagnosis, "it all makes sense", but did not express whether this was an explanation for the endoscopic appearance of BE.
I'm a 34 year old male. For about 8 years, I've had annual EGDs for GERD. The original chief complaint was dysphagia. I currently take 40 mgpantoprazole in the morning, and 300 mg of nizatidine before bed.During the 8 years of observation, I have occasionally had diagnoses of hiatal hernias (once on a barium swallow, but not confirmed by EGD), and several times of eosinophilic esophagitis. However, the EoE is somewhat inconsistent on biopsy. My most recent EGD biopsy was negative for EoE. My specific questions concern understanding something my gastroenterologist said during the follow-up consult.
He said that "endoscopically, it looked like there was evidence of Barrett's esophagus." However, the biopsies were negative for Barrett's, and he said that the biopsies were controlling (i.e., notwithstanding the appearance on endoscope, if the biopsies were negative, it was not Barrett's.
Still, I noticed on my insurance company's app, that the entry for the date of service (date of the EGD) indicated Barrett's without dysplasia. I'm hoping someone can help me reconcile all of this information.
1) Why would the insurance company record indicate Barrett's?
2) Is it correct that the biopsy is authoritative over the endoscopic appearance in the case of Barrett's?
3) Assuming I don't have Barrett's, as the biopsy would confirm, how can I avoid developing my chronic GERD into BE? Is this a futile effort?
4) if I ever do develop BE, what is the likelihood of this turning into a fatal cancer?
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016. On that EGD, Eosinophilic Esophagitis was confirmed by biopsy.
Finally, 5) concerning the eosinophilic esophagitis, is it possible to present intermittently (appearing on some biopsies some years, and then not on others)? Without elaborating, my doctor commented that with the historical EE diagnosis, "it all makes sense", but did not express whether this was an explanation for the endoscopic appearance of BE.
He said that "endoscopically, it looked like there was evidence of Barrett's esophagus." However, the biopsies were negative for Barrett's, and he said that the biopsies were controlling (i.e., notwithstanding the appearance on endoscope, if the biopsies were negative, it was not Barrett's.
Still, I noticed on my insurance company's app, that the entry for the date of service (date of the EGD) indicated Barrett's without dysplasia. I'm hoping someone can help me reconcile all of this information.
1) Why would the insurance company record indicate Barrett's?
2) Is it correct that the biopsy is authoritative over the endoscopic appearance in the case of Barrett's?
3) Assuming I don't have Barrett's, as the biopsy would confirm, how can I avoid developing my chronic GERD into BE? Is this a futile effort?
4) if I ever do develop BE, what is the likelihood of this turning into a fatal cancer?
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016. On that EGD, Eosinophilic Esophagitis was confirmed by biopsy.
Finally, 5) concerning the eosinophilic esophagitis, is it possible to present intermittently (appearing on some biopsies some years, and then not on others)? Without elaborating, my doctor commented that with the historical EE diagnosis, "it all makes sense", but did not express whether this was an explanation for the endoscopic appearance of BE.
Brief Answer:
Prokinetic drug should be added.
Detailed Answer:
Hello and thanks for choosing "Ask a Doctor" service for your query,
Have seen your details and i appreciate your concerns-
Answers are-
1)Insurance company comments were written on basis of endoscopy and not on the basis of reports of biopsy.
Gold standard test for barrett's id Biopsy.If its normal visual endoscopic reference makes no sense.
2)Obviously yes biopsy is the deciding factor.
3)By keeping Gastroesophageal reflux disease in control.
Along with antacid on which you are on Pantoprazole and nizatidine you should also take a prokinetic drug like domperidon 30mg once.This drug would prevent the reflux of acid from stomach to esophagus hence preventing recurrent esophageal injury and barretts esophagus.
Right now your medicines are only helping your body in controlling the amount of acid formed(they are antacid) adding a prokinetic drug would help to prevent acid reflux back into esophagus. This would reduce the chances of esophageal injury and further chances of any complication.
Secondly avoid smoking drinking and junk food.
Not at all a futile effort its 100% controllable but not curable.
4)Without proper treatment and unhealthy life style 10% cases of barrett's changes into adenocarcinoma.
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016.-Does not matters reports of 2019 are normal.
5)Esonophilic esophagitis as the name suggests-Esophagitis-Inflammation of esophagus
And when there is inflammation(chronic esonophils get accumulated in that area termed medically as Esonophilic esophagitis. This is a off and on recurrent phenomenon. Again if esophagus is not inflamed this won't happen.
Suggestion-
Question your doctor why he is not prescribing you a prokinetic drug.
Take this print out and consult him.
Hope i was straight forward and easy to understand.
Do reply with what your doctor says.
Thanks!
Prokinetic drug should be added.
Detailed Answer:
Hello and thanks for choosing "Ask a Doctor" service for your query,
Have seen your details and i appreciate your concerns-
Answers are-
1)Insurance company comments were written on basis of endoscopy and not on the basis of reports of biopsy.
Gold standard test for barrett's id Biopsy.If its normal visual endoscopic reference makes no sense.
2)Obviously yes biopsy is the deciding factor.
3)By keeping Gastroesophageal reflux disease in control.
Along with antacid on which you are on Pantoprazole and nizatidine you should also take a prokinetic drug like domperidon 30mg once.This drug would prevent the reflux of acid from stomach to esophagus hence preventing recurrent esophageal injury and barretts esophagus.
Right now your medicines are only helping your body in controlling the amount of acid formed(they are antacid) adding a prokinetic drug would help to prevent acid reflux back into esophagus. This would reduce the chances of esophageal injury and further chances of any complication.
Secondly avoid smoking drinking and junk food.
Not at all a futile effort its 100% controllable but not curable.
4)Without proper treatment and unhealthy life style 10% cases of barrett's changes into adenocarcinoma.
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016.-Does not matters reports of 2019 are normal.
5)Esonophilic esophagitis as the name suggests-Esophagitis-Inflammation of esophagus
And when there is inflammation(chronic esonophils get accumulated in that area termed medically as Esonophilic esophagitis. This is a off and on recurrent phenomenon. Again if esophagus is not inflamed this won't happen.
Suggestion-
Question your doctor why he is not prescribing you a prokinetic drug.
Take this print out and consult him.
Hope i was straight forward and easy to understand.
Do reply with what your doctor says.
Thanks!
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Brief Answer:
Prokinetic drug should be added.
Detailed Answer:
Hello and thanks for choosing "Ask a Doctor" service for your query,
Have seen your details and i appreciate your concerns-
Answers are-
1)Insurance company comments were written on basis of endoscopy and not on the basis of reports of biopsy.
Gold standard test for barrett's id Biopsy.If its normal visual endoscopic reference makes no sense.
2)Obviously yes biopsy is the deciding factor.
3)By keeping Gastroesophageal reflux disease in control.
Along with antacid on which you are on Pantoprazole and nizatidine you should also take a prokinetic drug like domperidon 30mg once.This drug would prevent the reflux of acid from stomach to esophagus hence preventing recurrent esophageal injury and barretts esophagus.
Right now your medicines are only helping your body in controlling the amount of acid formed(they are antacid) adding a prokinetic drug would help to prevent acid reflux back into esophagus. This would reduce the chances of esophageal injury and further chances of any complication.
Secondly avoid smoking drinking and junk food.
Not at all a futile effort its 100% controllable but not curable.
4)Without proper treatment and unhealthy life style 10% cases of barrett's changes into adenocarcinoma.
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016.-Does not matters reports of 2019 are normal.
5)Esonophilic esophagitis as the name suggests-Esophagitis-Inflammation of esophagus
And when there is inflammation(chronic esonophils get accumulated in that area termed medically as Esonophilic esophagitis. This is a off and on recurrent phenomenon. Again if esophagus is not inflamed this won't happen.
Suggestion-
Question your doctor why he is not prescribing you a prokinetic drug.
Take this print out and consult him.
Hope i was straight forward and easy to understand.
Do reply with what your doctor says.
Thanks!
Prokinetic drug should be added.
Detailed Answer:
Hello and thanks for choosing "Ask a Doctor" service for your query,
Have seen your details and i appreciate your concerns-
Answers are-
1)Insurance company comments were written on basis of endoscopy and not on the basis of reports of biopsy.
Gold standard test for barrett's id Biopsy.If its normal visual endoscopic reference makes no sense.
2)Obviously yes biopsy is the deciding factor.
3)By keeping Gastroesophageal reflux disease in control.
Along with antacid on which you are on Pantoprazole and nizatidine you should also take a prokinetic drug like domperidon 30mg once.This drug would prevent the reflux of acid from stomach to esophagus hence preventing recurrent esophageal injury and barretts esophagus.
Right now your medicines are only helping your body in controlling the amount of acid formed(they are antacid) adding a prokinetic drug would help to prevent acid reflux back into esophagus. This would reduce the chances of esophageal injury and further chances of any complication.
Secondly avoid smoking drinking and junk food.
Not at all a futile effort its 100% controllable but not curable.
4)Without proper treatment and unhealthy life style 10% cases of barrett's changes into adenocarcinoma.
I will add that prior EGDs have shown linear ulceration of the LE, which has healed, as well as "fissuring of the esophagus, suggestive of eosinophilic esophagitis", according to a report from 2016.-Does not matters reports of 2019 are normal.
5)Esonophilic esophagitis as the name suggests-Esophagitis-Inflammation of esophagus
And when there is inflammation(chronic esonophils get accumulated in that area termed medically as Esonophilic esophagitis. This is a off and on recurrent phenomenon. Again if esophagus is not inflamed this won't happen.
Suggestion-
Question your doctor why he is not prescribing you a prokinetic drug.
Take this print out and consult him.
Hope i was straight forward and easy to understand.
Do reply with what your doctor says.
Thanks!
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you kindly for your response. As a follow up, what are the chances that the biopsy missed the tissue section of BE? My doctor was explicit in telling me that he always does many biopsies and is very thorough. But I wonder what would give the appearance of BE but still be normal tissue
Thank you kindly for your response. As a follow up, what are the chances that the biopsy missed the tissue section of BE? My doctor was explicit in telling me that he always does many biopsies and is very thorough. But I wonder what would give the appearance of BE but still be normal tissue
Brief Answer:
Follow up.
Detailed Answer:
Hi again.
1)Practically not possible unless doctor has a fake certification or is under intoxicated state.
2)In Barretts esophagus the type of cells changes. In easy language if a Black cola bottle changes into Yellow lime juice how can you miss it.
Biopsy is the gold standard and if any doctor missed it you could directly XXXXXXX him.
Thank you.
Follow up.
Detailed Answer:
Hi again.
1)Practically not possible unless doctor has a fake certification or is under intoxicated state.
2)In Barretts esophagus the type of cells changes. In easy language if a Black cola bottle changes into Yellow lime juice how can you miss it.
Biopsy is the gold standard and if any doctor missed it you could directly XXXXXXX him.
Thank you.
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Follow up.
Detailed Answer:
Hi again.
1)Practically not possible unless doctor has a fake certification or is under intoxicated state.
2)In Barretts esophagus the type of cells changes. In easy language if a Black cola bottle changes into Yellow lime juice how can you miss it.
Biopsy is the gold standard and if any doctor missed it you could directly XXXXXXX him.
Thank you.
Follow up.
Detailed Answer:
Hi again.
1)Practically not possible unless doctor has a fake certification or is under intoxicated state.
2)In Barretts esophagus the type of cells changes. In easy language if a Black cola bottle changes into Yellow lime juice how can you miss it.
Biopsy is the gold standard and if any doctor missed it you could directly XXXXXXX him.
Thank you.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you again for your thoughtful and succinct reply.
In closing, and to not take up more of your time beyond this, have you had the opportunity to review the attached reports? The first shows the procedure impression (concluding BE), and the second is the pathology report (apparently showing no intestinal metaplasia in the three tissue samples from the GE junction. I am assuming that this translates to “rules out BE”.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE?
Thanks again, and a very happy and healthy new year.
In closing, and to not take up more of your time beyond this, have you had the opportunity to review the attached reports? The first shows the procedure impression (concluding BE), and the second is the pathology report (apparently showing no intestinal metaplasia in the three tissue samples from the GE junction. I am assuming that this translates to “rules out BE”.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE?
Thanks again, and a very happy and healthy new year.
Thank you again for your thoughtful and succinct reply.
In closing, and to not take up more of your time beyond this, have you had the opportunity to review the attached reports? The first shows the procedure impression (concluding BE), and the second is the pathology report (apparently showing no intestinal metaplasia in the three tissue samples from the GE junction. I am assuming that this translates to “rules out BE”.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE?
Thanks again, and a very happy and healthy new year.
In closing, and to not take up more of your time beyond this, have you had the opportunity to review the attached reports? The first shows the procedure impression (concluding BE), and the second is the pathology report (apparently showing no intestinal metaplasia in the three tissue samples from the GE junction. I am assuming that this translates to “rules out BE”.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE?
Thanks again, and a very happy and healthy new year.
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
Pathology reports are main as the sample of tissue taken out is seen under high power microscope.
Clearly written reflux esophagitis is there which means inflammation is there due to reflux of acid.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE? -No doctor wants to take risk and if he if he suspects some thing odd or to be on safe side biopsies are taken.....This answer could be given by the treating doctor only as its difficult to know what was he seeing or was there in his mind while doing scopy.
Hope i was helpful,
Feel free to follow up,
Start a prokinetic drug.
Have a happy life ahead.
Wish you a merry christmas and a very happy new year from us too.
Follow up answer.
Detailed Answer:
Hi again,
Pathology reports are main as the sample of tissue taken out is seen under high power microscope.
Clearly written reflux esophagitis is there which means inflammation is there due to reflux of acid.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE? -No doctor wants to take risk and if he if he suspects some thing odd or to be on safe side biopsies are taken.....This answer could be given by the treating doctor only as its difficult to know what was he seeing or was there in his mind while doing scopy.
Hope i was helpful,
Feel free to follow up,
Start a prokinetic drug.
Have a happy life ahead.
Wish you a merry christmas and a very happy new year from us too.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
Pathology reports are main as the sample of tissue taken out is seen under high power microscope.
Clearly written reflux esophagitis is there which means inflammation is there due to reflux of acid.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE? -No doctor wants to take risk and if he if he suspects some thing odd or to be on safe side biopsies are taken.....This answer could be given by the treating doctor only as its difficult to know what was he seeing or was there in his mind while doing scopy.
Hope i was helpful,
Feel free to follow up,
Start a prokinetic drug.
Have a happy life ahead.
Wish you a merry christmas and a very happy new year from us too.
Follow up answer.
Detailed Answer:
Hi again,
Pathology reports are main as the sample of tissue taken out is seen under high power microscope.
Clearly written reflux esophagitis is there which means inflammation is there due to reflux of acid.
However, what would account for a visual appearance of BE on endoscopy that would lead to the original impression of BE? -No doctor wants to take risk and if he if he suspects some thing odd or to be on safe side biopsies are taken.....This answer could be given by the treating doctor only as its difficult to know what was he seeing or was there in his mind while doing scopy.
Hope i was helpful,
Feel free to follow up,
Start a prokinetic drug.
Have a happy life ahead.
Wish you a merry christmas and a very happy new year from us too.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you Dr. XXXXXXX I will follow up with my doctor about a pro-kinetic and will try to learn more about what may have given the appearance of Barrett’s.
Do you imagine it’s possible that the esophagitis/inflammation itself can give an appearance suspicious of BE?
Do you imagine it’s possible that the esophagitis/inflammation itself can give an appearance suspicious of BE?
Thank you Dr. XXXXXXX I will follow up with my doctor about a pro-kinetic and will try to learn more about what may have given the appearance of Barrett’s.
Do you imagine it’s possible that the esophagitis/inflammation itself can give an appearance suspicious of BE?
Do you imagine it’s possible that the esophagitis/inflammation itself can give an appearance suspicious of BE?
Brief Answer:
Follow up answer.
Detailed Answer:
Hello there and thank you for follow up,
See Barrett's esophagus in simple language means change of one type of cell to another type(usually esophagus contains cells which are not resistant to acid while stomach contains cells resistant to acid).Both of them are seperated by a band called gastroesophageal band.
When for years acid keeps on regurgitating back into esophagus body as a protective phenomenon starts changing acid susceptible cell into acid resistant cell of stomach.Now if a particular area is inflamed (reddish in color) its really difficult to see visually the nature of cells,Secondly these changes occurs over years.
Thats why small sample of tissue is taken for biopsy to read it under microscope. Each type of cell stains under different type of XXXXXXX so a pathologist can detect it very easily.
So yes off course if a particular area is inflamed its really difficult to see the type of cells in that area and any gastroenterologist would send tissue sample for Biopsy.Basically it aslso depends on doctor to doctor....Just like an air craft could be driven by a number of pilots all having same skills but yet there is a difference in practical vs theoretical skills of every pilot(just an example).
Hope i was easy to understand,
Any further query are welcome,
If satisfied do rate the answer,
Suggestions to make answers better and more easy to understand are welcome.
Follow up answer.
Detailed Answer:
Hello there and thank you for follow up,
See Barrett's esophagus in simple language means change of one type of cell to another type(usually esophagus contains cells which are not resistant to acid while stomach contains cells resistant to acid).Both of them are seperated by a band called gastroesophageal band.
When for years acid keeps on regurgitating back into esophagus body as a protective phenomenon starts changing acid susceptible cell into acid resistant cell of stomach.Now if a particular area is inflamed (reddish in color) its really difficult to see visually the nature of cells,Secondly these changes occurs over years.
Thats why small sample of tissue is taken for biopsy to read it under microscope. Each type of cell stains under different type of XXXXXXX so a pathologist can detect it very easily.
So yes off course if a particular area is inflamed its really difficult to see the type of cells in that area and any gastroenterologist would send tissue sample for Biopsy.Basically it aslso depends on doctor to doctor....Just like an air craft could be driven by a number of pilots all having same skills but yet there is a difference in practical vs theoretical skills of every pilot(just an example).
Hope i was easy to understand,
Any further query are welcome,
If satisfied do rate the answer,
Suggestions to make answers better and more easy to understand are welcome.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Brief Answer:
Follow up answer.
Detailed Answer:
Hello there and thank you for follow up,
See Barrett's esophagus in simple language means change of one type of cell to another type(usually esophagus contains cells which are not resistant to acid while stomach contains cells resistant to acid).Both of them are seperated by a band called gastroesophageal band.
When for years acid keeps on regurgitating back into esophagus body as a protective phenomenon starts changing acid susceptible cell into acid resistant cell of stomach.Now if a particular area is inflamed (reddish in color) its really difficult to see visually the nature of cells,Secondly these changes occurs over years.
Thats why small sample of tissue is taken for biopsy to read it under microscope. Each type of cell stains under different type of XXXXXXX so a pathologist can detect it very easily.
So yes off course if a particular area is inflamed its really difficult to see the type of cells in that area and any gastroenterologist would send tissue sample for Biopsy.Basically it aslso depends on doctor to doctor....Just like an air craft could be driven by a number of pilots all having same skills but yet there is a difference in practical vs theoretical skills of every pilot(just an example).
Hope i was easy to understand,
Any further query are welcome,
If satisfied do rate the answer,
Suggestions to make answers better and more easy to understand are welcome.
Follow up answer.
Detailed Answer:
Hello there and thank you for follow up,
See Barrett's esophagus in simple language means change of one type of cell to another type(usually esophagus contains cells which are not resistant to acid while stomach contains cells resistant to acid).Both of them are seperated by a band called gastroesophageal band.
When for years acid keeps on regurgitating back into esophagus body as a protective phenomenon starts changing acid susceptible cell into acid resistant cell of stomach.Now if a particular area is inflamed (reddish in color) its really difficult to see visually the nature of cells,Secondly these changes occurs over years.
Thats why small sample of tissue is taken for biopsy to read it under microscope. Each type of cell stains under different type of XXXXXXX so a pathologist can detect it very easily.
So yes off course if a particular area is inflamed its really difficult to see the type of cells in that area and any gastroenterologist would send tissue sample for Biopsy.Basically it aslso depends on doctor to doctor....Just like an air craft could be driven by a number of pilots all having same skills but yet there is a difference in practical vs theoretical skills of every pilot(just an example).
Hope i was easy to understand,
Any further query are welcome,
If satisfied do rate the answer,
Suggestions to make answers better and more easy to understand are welcome.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thanks again. The aviation analogy is helpful.
Further, I understand the risk-averse nature of medicine and the need to biopsy anything suspicious.
I suppose what troubles me is the apparent conclusiveness of the Dx on the procedure report, and the specific observations of mucosal tongues (which were a new finding, and were not reported on previous EGDs).
I’ve read that an irregular Z-line can give the appearance of Barrett’s, but as I’ve had many EGDs, it would seem strange that this would be the first time that was observed. Unless the z-line is something that can change over time.
I’ve also read about the possibility of gastric heterotopia at the distal esophagus giving the appearance of BE. However, I understand this to be rare—and perhaps it would have been observed on the biopsies (although the pathology report just says “no intestinal metaplasia” without reference to gastric metaplasia.
I am hopeful that the more likely explanation is that the endoscopic diagnosis was more likely caused by inflammation of the distal esophagus that gave a BE appearance.
Do you have any final thoughts on the above?
A very happy and healthy new year to you and your family.
Further, I understand the risk-averse nature of medicine and the need to biopsy anything suspicious.
I suppose what troubles me is the apparent conclusiveness of the Dx on the procedure report, and the specific observations of mucosal tongues (which were a new finding, and were not reported on previous EGDs).
I’ve read that an irregular Z-line can give the appearance of Barrett’s, but as I’ve had many EGDs, it would seem strange that this would be the first time that was observed. Unless the z-line is something that can change over time.
I’ve also read about the possibility of gastric heterotopia at the distal esophagus giving the appearance of BE. However, I understand this to be rare—and perhaps it would have been observed on the biopsies (although the pathology report just says “no intestinal metaplasia” without reference to gastric metaplasia.
I am hopeful that the more likely explanation is that the endoscopic diagnosis was more likely caused by inflammation of the distal esophagus that gave a BE appearance.
Do you have any final thoughts on the above?
A very happy and healthy new year to you and your family.
Thanks again. The aviation analogy is helpful.
Further, I understand the risk-averse nature of medicine and the need to biopsy anything suspicious.
I suppose what troubles me is the apparent conclusiveness of the Dx on the procedure report, and the specific observations of mucosal tongues (which were a new finding, and were not reported on previous EGDs).
I’ve read that an irregular Z-line can give the appearance of Barrett’s, but as I’ve had many EGDs, it would seem strange that this would be the first time that was observed. Unless the z-line is something that can change over time.
I’ve also read about the possibility of gastric heterotopia at the distal esophagus giving the appearance of BE. However, I understand this to be rare—and perhaps it would have been observed on the biopsies (although the pathology report just says “no intestinal metaplasia” without reference to gastric metaplasia.
I am hopeful that the more likely explanation is that the endoscopic diagnosis was more likely caused by inflammation of the distal esophagus that gave a BE appearance.
Do you have any final thoughts on the above?
A very happy and healthy new year to you and your family.
Further, I understand the risk-averse nature of medicine and the need to biopsy anything suspicious.
I suppose what troubles me is the apparent conclusiveness of the Dx on the procedure report, and the specific observations of mucosal tongues (which were a new finding, and were not reported on previous EGDs).
I’ve read that an irregular Z-line can give the appearance of Barrett’s, but as I’ve had many EGDs, it would seem strange that this would be the first time that was observed. Unless the z-line is something that can change over time.
I’ve also read about the possibility of gastric heterotopia at the distal esophagus giving the appearance of BE. However, I understand this to be rare—and perhaps it would have been observed on the biopsies (although the pathology report just says “no intestinal metaplasia” without reference to gastric metaplasia.
I am hopeful that the more likely explanation is that the endoscopic diagnosis was more likely caused by inflammation of the distal esophagus that gave a BE appearance.
Do you have any final thoughts on the above?
A very happy and healthy new year to you and your family.
Brief Answer:
Follow up answer.
Detailed Answer:
Hello again my dear
My final thought is what we are taught from first day of medical school and that is Rare thing do occur but occurs rarely so we have to abide by the finding of biopsy.
As written by you there could be a number of signs of Barrett's esophagus but if biopsy is normal everything is ok.
You just need to follow proper medication and diet changes.
Hope i was helpful,
Follow ups are welcome.
Merry christmas and a very happy new year,
May you get well soon!
Follow up answer.
Detailed Answer:
Hello again my dear
My final thought is what we are taught from first day of medical school and that is Rare thing do occur but occurs rarely so we have to abide by the finding of biopsy.
As written by you there could be a number of signs of Barrett's esophagus but if biopsy is normal everything is ok.
You just need to follow proper medication and diet changes.
Hope i was helpful,
Follow ups are welcome.
Merry christmas and a very happy new year,
May you get well soon!
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
Follow up answer.
Detailed Answer:
Hello again my dear
My final thought is what we are taught from first day of medical school and that is Rare thing do occur but occurs rarely so we have to abide by the finding of biopsy.
As written by you there could be a number of signs of Barrett's esophagus but if biopsy is normal everything is ok.
You just need to follow proper medication and diet changes.
Hope i was helpful,
Follow ups are welcome.
Merry christmas and a very happy new year,
May you get well soon!
Follow up answer.
Detailed Answer:
Hello again my dear
My final thought is what we are taught from first day of medical school and that is Rare thing do occur but occurs rarely so we have to abide by the finding of biopsy.
As written by you there could be a number of signs of Barrett's esophagus but if biopsy is normal everything is ok.
You just need to follow proper medication and diet changes.
Hope i was helpful,
Follow ups are welcome.
Merry christmas and a very happy new year,
May you get well soon!
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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