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Dr. Andrew Rynne

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Does hiatus hernia with mild gastritis and lump in the throat indicate esophagus cancer?

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1924 Questions

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Posted on Sat, 10 Mar 2018 in Cancer
Question: Can this be esophagus cancer or something else? Worried it might be esophagus cancer.
Symptoms: 23 year old male, about 1.6 (1 year and 6 months ago), upper endoscopy was done with no esophagitis , normal biopsy of esophagus.

Hiatus hernia was found with mild gastritis.

I have been suffering from anxiety since on 3 attemtps i have tried to reduce my ssrr citalopram pills but i go withdrawls. Now my anxiety is back and i have feeling like a lump is stuck in my throat and have difficulty swallowing . yesterday for breakfast i had trouble swallowing and no difficulty for lunch and dinner.

Today 2 meals , i kept having difficulty swallowing and feeling like a lump like feeling in my throat. In the past 1.6 years i didnt have much heart burn but i had a feeling of something coming back up my throat and this has been consistent for the 1.6 years everyday. I get heartburn maybe once every couple of weeks but its not very long lasting and not severe.

im worried can this be cancer? would i need to have another endoscopy done?

My symptoms are also lack of appetite and weight loss but these symptoms happened before the difficulty swallowing.
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Repeat endoscopy has to be done to rule out achalasia cardia.

Detailed Answer:
Hello Dear patient,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

Achalasia is a esophageal motility disorder in which there is absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter in response to swallowing.Impaired relaxation of esophageal sphincter can also be responsible for feeling of food struck in stomach.Due to long term uncontrolled GERD and acid reflux in esophagus the normal squamous cells may be replaced by columnar cells of gut this is called Metaplasia and would lead to XXXXXXX esophagus and it often contributes to the advanced symptoms of the condition.Metaplasia increases the risk of future adenocarcinoma by 10%.

A repeat endoscopy should be done asap.

Secondly request your gastroenterologist to start you on PPI-antacids like Rabeprazole with Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.
An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.
Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily should be taken.

Anxiety stimuates the vagus nerve and would cause reflux of acid into esophagus.
Please start Paroxetine SSRI in doses of 25 mg a day after consulting your pyschaitrist.

Whether its Metaplasia or carcinoma or achalasia can be differenciated only after a endoscopy.
Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Ramesh Kumar 40 hours later
What are my chances of it being carcinoma? I had the difficulty swallowing for 2 days now ' and you said it could either be the three things could it esophaghitis?
doctor
Answered by Dr. Ramesh Kumar 9 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello,
Symptoms are typical of carcinoma hence should be investigated immediately.
Possible chances are 50-50.

Severe esophagitis would result in XXXXXXX esophagus which gain increases the risk of cancer by 10-15%.
All these things are inter related.Cancer does not develop overnight.When symptoms are over looked for long period of time initially body changes squamous cells(sensitive to acid) into columnar cell resistant to acid) this is called metaplasia however if the problem is not controlled even at this stage it further give rise to cancer.

Go for endoscopy and things would be clear.

Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Ramesh Kumar 34 hours later
I went to my doctor and he said it's very unlikely as my esophagus biopsies were normal and I did not have esophaghitis 1.6 years ago. The thing is I don't have problem swallowing all the time ' he stated it's only been a few days so he won't refer me for an endoscopy. I will still push him to get this done .

If I have been taking liquid acid reducer for 1.6 yeats when I had the symptoms would this reduce my chances of Barret's and cancer.
doctor
Answered by Dr. Ramesh Kumar 19 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
If your doctor is not ready for biopsy then start taking
A proton pump inhibitor nexium 40 mg twice daily.
Keep taking antacid syrup 3 tsf twice daily.
If pain responds to it its esophagitis and endoscopy has to be done.

Yes controlling symptoms properly through medications would lower chances of progessing of XXXXXXX esophagus into carcinoma.

Regards
Above answer was peer-reviewed by : Dr. Kampana
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