Barretts

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Hi i recently had an endoscopy and the biopsied for Barretts.

I have been doing plenty oh Googling anf found some quite scary stuff.

I have some questions that i hope can be answered .

It eould appear thst the chances of Barretts mutating into cancer are about 0.5% per year. Thst sounds low intil you work it out into life years . So a 50 year old that lives to 90 ( hoprfully) has a 0.5 miltiplied by 40 chance ie 20% chance . Thst seems pretty high to me . 

Also i understand that you can have regular endoscopies to catch it before it turns, ablation therapy etc . If these options are available why do so many people with Barretts still go on to get OC ?  I hope someone can shed dome light as i have not seen my consultant for biopsy result yet.

Thank you

Darren 

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  • Posted

    1) the .5% per year number has been shown to be a bit high. It depends on the length of your BE.  Rough estimate is .1% per year per centimeter. This is part of the reason Irregular Z-lines are not regularly biopsied: they’re not likely to turn to cancer even if they’re metaplastic.  (There is a lot of argument on this. I’ve gotten 2 opinions on this myself, as I have an irregular Z-line with gobblet cells. One center said it doesn’t require regular scoping, another center said yes, it does.)

    Your math, however, is fundamentally correct.  

    2) scoping guidelines are every 2-3 years not some centers, 3-5 in others. Depends on a few factors. 

    3) Betwen 90-95% of people who are diagnosed with EC come in for the first time with EC. Most people who come in with EC don’t know they have Barrett’s. Most people with Barrett’a don’t get EC. In a sense, those whose Barrett’a is discovered and who are in regular scoping programs are the lucky ones. 

    Side note: there is some disagreement on whether those with non-displastic BE should be ablated. For some it’s best to a late at any stage. For others it depends on the length. 

     I can’t say don’t worry because I do, all the time. But don’t worry too much: that will make it worse.  Eat better, follow your diet and medical regimen, and you should be fine. Consider surgery if you’re a candidate. And consider moving to a low-fat diet, preferably mostly vegetarian. People I know who had  Barrett’s have gotten good results from that. (Read “Eat to Live” by Dr Furhman.) 

    Best of luck. 

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    • Posted

      Thanks Norb, so if you do get HGD can it be fixed with ablation ? I’m confused why everyone who develops Barretts then HGD is not ablated ? Surely they are scoped and it’s discovered so why the comparative high risk of OC ? 

      Or are those documented figures allowing for people undiagnosed and so it’s too late ? 

      Thanks again 

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    • Posted

      HGD and even Stage 0 cancers can be ablated. In fact, the protocol is now to ablate at LGD or even indefinite for dysplasia, with some arguing ANY Barrett’s should be ablated. 

      Not sure I understand your second question. Do you mean to to ask whether the numbers (.1% chance per year) account for those people who were not know to have cancer? 

      I don’t know, but I don’t think so. I think that number only accounts for those people who have been observed to have Barrett’s and have been scoped for a long time. 

      The thought goes that a minority of people with Barrett’s know about it. Some time ago, a study involving a large number of deceased folks revealed that, on autopsy, something like 2-5% of folks had recognizable Barrett’s. (The number is somewhere in there, but I don’t remember the exact number.) Most were not diagnosed, and it’s suspected that ~3% of the total US population has Barrett’s. Most just don’t know it. And most will live nd die never knowing. 

      Remember, even with Barrett’s, EC is very rare. In the US you’re talking about 17,000 new cases per year*. This is a very small number. 

      *That number includes all esophageal cancers. Barrett’s is only a risk factor for adenocarcinomas, which make up something like 80% of all EC in western countries. But that number does NOT include adenocarcinomas of the Gastroesophageal Junction (GEJ) or upper stomach, even though some consider those to all be effectively the same type of cancer. And once you look at those numbers, stats change a bit. 

      Anyway, it sounds like you’re trying to stratify your own level of risk, trying to gain some comfort from the numbers. I know because I do the same. So take it from me when I say that numbers don’t matter. The only number that matters in 1: you.  This is a wake up call. You can do things to avoid cancer. Do them. Do not wait. 

      Best of luck. 

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    • Posted

      Thanks Norb for your informative reply . If even LGD Is ablated and I understand that procedure is very successful,then why does anyone with diagnosed Barretts progress to Cancer ? That’s the bit I’m struggling with . Surely the scope and biopsy picks up the change and it’s dealt with . So why then do around 10 % of Barretts pantients get cancer ? 

      Many thanks 

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  • Posted

    What made you test for barretts. I have been suffering for years with this. One ear nose and throat dr. Told me, if I don't do the surgery, linx, I will eventually have cancer. I have a pain in my back now, due to acid. I know it is. I have silent reflux. Acid just eating away at you slowly. I take deviant everyday. Sometimes I don't take it. Try to eat right. I have a hiatus hernia. Think I'm really a candidate for the surgery

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    • Posted

      Thank you Tata , I was scoped because my reflux was not being stopped by PPIs . I was a bit out of it but remember the consultant saying he saw an HH and had done a biopsy for Barretts . That’s all I remember . 
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  • Posted

    Hi, I too have been diagnosed with Barrett’s oesphagus metaplasia after having nissin fundulpication surgery for a incarcerated hiatal hernia.  It frightened the hell out of me at first till they reassured me that it’s very rare that the cells change.  They will also do regular camera work and take biopsies just to keep a check.  I know it’s easier said than done but please try not to worry too much as that in itself can cause heartburn, inflammation.  Keep on a healthy diet away from the foods/drinks that irritate the oesophagus and I’m sure like me you’ll be fine. I was diagnosed 3 years this October.  Hope this helps x
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