Barrett's not under control

Hi Chris, 

Thank you very much for the very detailed reply. You have put my mind at ease. I think the bleeding may be from the stomach but it is intermitant and i have had a lot of constipation but hopefully nothing serious and it sorts itself out. Can acid cause bleeding Chris?

I will make sure i keep a food diary and see which foods work for me and which dont. I recently had terrible pain after egg so i have been staying away from them. 

I am glad you barrett's had stayed away and i hope it continues too.

Thomas 

Also i take it as i am being scoped every 2 years that i must have 3cm or greater.

Simalip, you're correct in saying there is an increased risk of developing cancer if you have Barrett's Oesophagus and I am aware the lifetime risk shows increased chance over 20 years.

Oesophageal Adenocarcinoma is currently the 8th most prevalent cancer and the number 5 cancer killer in the UK which has the highest per capita rate of this in the world.

It's identifiable precursor lesion is Barrett's Oesophagus which is what the charity I co-founded and chair in UK, Barrett's Wessex, focusses on. "Our principal aim is to reduce the number of deaths to oesophageal cancer through raising awareness of its predominant pre-cancerous lesion, Barrett's Oesophagus."

In US some years ago, based on cadaver studies, the Ryan Hill foundation discovered at death (from whatever cause), 1 person in 70 of the population had Barrett's Oesophagus though only 10% knew it.

Transferring that figue to UK would mean we have 1 million with the disease and 8000 a year are dying here from OAC. However, I agree figures may actually be grossly underestimated. US has 5 times the population of UK but only twice the number of annual deaths from OAC so it may be in UK we could even have 2.5 million with Barrett's Oesophagus.

However, we must not be alarmist. Those diagnosed with Barrett's can be considered the lucky ones as regular surveillance scoping every few years will identify any pre-cancerous dysplastic changes early enough to be ablated. It's those who are unaware they have it who are likely not to know until the condition has actually become cancerous when it may be too late with a prognosis measured in weeks rather than years.

The most recent risk figures we commissioned from the statistics branch of cancer Research UK last year which took into account numerous studies in Europe and America, shows an annual progression risk of 0.7% from Non-Dysplastic Barrett's, 1% from Low Grade Dysplasia and 6% from High Grade Dysplsia.

Barrett's Oesophagus is a cellular change from squamous cells to columnar cells as a protection to the body to prevent it digesting itself.

Both Acid and bile are both needed. Bile acts as the surfactant required for the acid to attack animal tissue and fats.

A study from University of Rochester NY published August 2013, found "bile at low pH, but not bile or low pH alone" is required.

To reduce risk of development of Barrett's, we need to control at least one of the elements of acid, bile or reflux. The easiest is to reduce acid using PPIs.

The Keck video you link to is actually a promotion of the LINX device which will not stop the possibility of progression to cancer if it is to occur - in the same way as I know my fundoplication will not stop possible progression of mine.

To minimise the risks of progression, Barrett's cells may be ablated. However, since this will not remove the underlying cause for the Barrett's to have developed initially, acid suppressant medication or reflux reduction surgery is required subsequent to completing a course of ablation therapy and continuation of surveillance.

Dear Barrett's,

I know you say bile and acid are both necessary, but I have read times that acid suppression therapy enhances bile acid effects. So in agreement with some part of what you say, since bile is worse, it is better if we control bile, or both. Suppressing just the acid may not be good.

One more thing since PPIs can make you feel better and vanish symptoms, you may need to do endoscopy every several years. Search for "Dr Blair jobe Heartburn meds tied to cancer". This is not to scare you. It's just a warning that everyone taking PPIs (not sure about antacids) should do endoscopy every several years.

Thanks for reminding me of the July 2011 Pittsburgh study "Gastroesophageal Reflux Disease Symptom Severity, Proton Pump Inhibitor Use, and Esophageal Carcinogenesis." From other studies, around 40% of people refluxing acid do not experience the recognisable symptoms of heartburn, It does make sense that they could be more liable to carcinogenesis since it's not so easy for them to determine the efficacy of medication.

I agree the importance of regular endoscopy as recommended by BSG and ACG. I always say those of us who know we have Barrett's are the lucky ones since we receive regular surveillance.

Although there may be a possibility of increased bile when reducing stomach acid (see "Suppression of Gastric Acid Secretion in Patients With Gastroesophageal Reflux Disease Results in Gastric Bacterial Overgrowth and Deconjugation of Bile Acids" - Theisen et al 2000), bile has the nature of an emulsifier and is rarely acidic on its own. It works to bind the concentrated hydrochloric acid to the mucosal layer in attacking the oesophageal epithelium. Whereas we can easily reduce the acid, it's not easy to reduce the bile. It is probably better to reduce the reflux but patients are notoriously bad at managing that and the surgical alternative is too frequently discounted.

I agree with barretts Wessex ... We who are being scoped every few years are the lucky ones..... We hopefully are aware of the situation we are in.... It's the larger population who unknowingly have barretts that do not realise the warnings until it is too late that need all this information. We are there with our repeat endoscopies.... Nothing I can do about my hernia ( fundoplacation being considered) bur would love to have been more informed earlier on about whT could cause heartburn etc.... From pregancy to being diagnosed 25 years later I accepted it as a fact of life. More info to the masses I say, about the importance of not eating late etc etc ... Thank you barretts for your support.