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Diagnosed with gerd and hiatus hernia. Have acid reflux. Should I get worried about barrett's?

Jan 2013
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Answered by

Internal Medicine Specialist
Practicing since : 2003
Answered : 1658 Questions
hope some one can help, i have acid reflux for 6 years now was diag 6 years ago with gerd and hiatus hernia, small sliding, i have been taken PPI zoton 15 mg one a day for 7 years whats the long term side effects?

also when someone has GERD do i need to be scoped so often has routine? or not? i have only had one scope 6 years ago, or do they only do scopes when required or other symptoms'?

i do worry about barrets ;o(
i get lots of anoying belching, wind sometimes acid thats if i eat the wrong foods, but if i lived on a bland diet there would be no enjoyment, i do try to eat healthy and swim regular im 5,11 and weigh 12 stone so not over weight

thanks XXXXXXX
Posted Fri, 20 Jul 2012 in Digestion and Bowels
Answered by Dr. Mayank Bhargava 7 hours later

1) You are suffering from Gastro-esophageal reflux disorder, which is very distressing and may lead to Barrett’s esophagus and Adenocarcinoma of lower esophagus.

2) Presence of GERD with Hiatus Hernia may lead to development of recurrent acid exposure of lower esophagus and may lead to dysplastic changes.

3) In majority of cases, GERD with hiatus hernia is managed by medicines. Surgery is needed when symptoms are not controlled by medical therapy. Surgery performed for Hiatus hernia is Nissan's Fundoplication.

4) You are taking Zoton 15mg (Lansoprazole) OD, while you can take the same medicine for twice in a day for more than 5 years without any major side effects (mentioned din CGDT 2010). Adenocarcinoma of gastric mucosa has been defined in studies on rats but not in human beings. If you have any allergic reaction after taking zoton then you may switch over to any other PPI.

5) If we compare the available PPI, then Lansoprazole is not a good PPI. Best to worst PPI in decreasing order is Esmoprazole (best)> Rabeprazole> Pantoprazole> Lansoprazole> Omeprazole (worst). Esmoprazole is best because it suppress acid secretion up to pH 2 and for a longer duration. You can choose Esmoprazole 40 mg BD. It is a prescription drug.

6) The best way to decrease acid secretion is to take PPI BD and H2 antagonist (Ranitidine, Famotidine, Lafutidine, Cimetidine) at bedtime. You should also take Prokinetics (Itopride, Cinitapride, Levosulpride) along with PPI. If prokinetics are not sufficient, then you can use Domperidone 20 mg TDS along with prokinetics+ PPI.

7) You should also follow few dietary changes:

a)     Avoid tomato, citrus fruits, tea, coffee, chocolates, onion, garlic, oily & spicy food

b)     Avoid cereals, legumes (will help you to decrease flatulence)

c)     Take only 200 ml of milk in a day and in the morning hours, more than this will form excessive gas.

d)     Take small frequent meals to avoid reflux

e)     Do not take oily food during dinner.

f) Keep distance if 3 hours between dinner and sleep.

g) Take Soft diet with curd (Preferred diet)

8) You should go for Endoscopy every 3 years for screening of Barrett’s esophagus and dysplastic changes.

9) You should consult to your family physician/ gastroenterologist.

Hope this will help you. Please do write back in case you have follow up queries to ask.

I wish you speedy recovery.

Dr. Mayank Bhargava
Above answer was peer-reviewed by
Follow-up: Diagnosed with gerd and hiatus hernia. Have acid reflux. Should I get worried about barrett's? 10 hours later
how many people who have GERD and reflus and a hernia go on to develeop barrets or cancer whats the percentage

i have just checked it was 4 years and 6 months when i was scoped there was no inflamation or gastrics at that time

would my GP? refer me for a scope if there are no issues? and hear in the UK i dont think they will do routine scopes only if they are issues, however i will ask i would prefer the new procedure PILL CAM as i dont like the scopes!

would my gp change my meds to Esmoprazole 40 mg BD could i just ask him?

what is prokinetics are not sufficient, then you can use Domperidone 20 mg TDS
Answered by Dr. Mayank Bhargava 1 hour later

1) Risk of developing Barrett's esophagus in GERD is 8-20% (Tadataka Yamada, Text of Gastroenterology 5th edition )

2) Risk of developing Adenocarcinoma of esophagus in Barrett's esophagus is 0.2-2.9% (Tadataka Yamada, Text of Gastroenterology 5th edition )

3) If you are symptoms free then there is no need of endoscopy. Endoscopy is required for screening of Barrett's esophagus and early detection may prevent major complication. Every 3 years endoscopy will keep early detection of any complication.

4) Pill Cam is Capsule endoscopy, and this will help in finding disease in whole gastrointestinal tract like stomach, small intestine and large intestine. For disease confined to upper gastrointestinal tract, there is no need of capsule endoscopy. This will provide only pictures, not live videos. Capsule endoscopy also do not help in taking biopsy.

5) Yes, if Esmoprazole if FDA approved and available in UK, you can go for it.

6) Prokinetics are those medicine which increase gut motility and will help in GERD. Use of prokinetics forces food to go ahead and prevent recurrent acidic injury to esophagus. Use of Metoclopramide (also a prokinetics) will constrict lower esophageal sphincter and increase gut motility.

Thanks and get well soon

Dr. Mayank Bhargava
Above answer was peer-reviewed by
Follow-up: Diagnosed with gerd and hiatus hernia. Have acid reflux. Should I get worried about barrett's? 1 hour later
So are you saying tht there needs to be an endo done every three years even if a person just has a hiatus hernia
So for example me
Hiatus hernia and GERD last scope four and a half years ago
Symptoms just more than normal wind some belching but not much
Does not affect my sleep
So would I need another endoscope or not? Or is this only to be done of more symptoms are there?
Answered by Dr. Mayank Bhargava 13 minutes later

Answering your query may have different opinion from different doctor. In my opinion, you should go for endoscopy as you are symptomatic and at high risk of Barrett's esophagus.

Risk of Barrett's esophagus in GERD is more in male as compared to female and more in European countries. Considering all these facts, you should opt for regular follow up.

We have observed few patients in which adenocarcinoma of esophagus was found and they were asymptomatic throughout their life.

So waiting for more symptoms may deteriorate your condition if you are unlucky.


Dr. Mayank Bhargava
Above answer was peer-reviewed by
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