Posted , 3 users are following.
There is lots of information regarding dysplasia... Low to high, high to OAC, likelihood of progression. However there is little known, it seems, about the changes from no dysplasia to low or high. What are the chances? It seems low but I've read NDBE can progress to OAC without the intervening LGD and HGD. Any thoughts?
Thank you.
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Barretts Robert_Emmet
Posted
I like to use the analogy of dominoes. The normal squamous cells that line a healthy oesophagus are like dominoes lying on a table. In Barrett's oesophagus, these are replaced by columnar cells, like dominoes standing on end. These columnar cells have a smaller surface area to be attacked by acid and the nerve endings are further from any acid so reduces pain. I like to think of Barrett's as being a friend that is standing in th eline of fire of acid being thrown at your body that could digest it.
Unfortunately, in a very small number of cases (about 0.2% pa) , these cells can become malevolent and mutate to dysplasia. Low grade dysplasia is when one or two of the dominoes are leaning aganst each other. High Grade dysplasia is when they topple. Cancer is a heap of dominoes.
(See the attached graphics of the dominoe metaphor and cell progression diagram form Johns Hopkins. )
Chances of progression from LGD are about 1%pa and from HGD about 6%pa
Non-Dysplastic Barrett's will not change to OAC without the intervening stages but these can happen, in a very small number of cases quickly so the intervening stages are not observed within the normal surveillance scoping interval..However, you are aware you have Barrett's and will be aware of any changes in your condition that could herald the possibility of cancer forming. It should still be found at an early enough stage (T1 or less) to be easily eradicated. It's those who don't know they have this condition who will not actually present or see a doctor until it is too late. Once the cancer has progressed too far, there's not much that can be done.
Robert_Emmet Barretts
Posted
Thank you for the response. I was diagnosed 3 years ago with non dysplastic BO, short segment. However there were obvious "suspicious changes" noted in the year follow up endoscopy . This turned out to be again with no dysplasia, however, it was obviously larger even after intense PPI therapy. I'm due for another scope in 2018, but my PCP suggested I should go this summer based on the report of changes. My GE and PCP are in the same health care system so the PCP can also see the diagnosis.