Progression of Barretts

Thank you so much Barretts and many apologies for not acknowledging your detailed reply before now.

My barretts was discovered when i had an epiglottic cyst removed about 3 years ago.  It was I cm at that time.  The next endoscopy showed 2cm, both these being non-circumferal.

Latest shows 4cm circumferal (sp?). 

I was diagnosed with reflux and HH about 30 years ago via a barium meal. My GP was just delighted that i didnt have stomach cancer, saying symptoms were same as i was reporting.  Nothing was advised about managing reflux and as i had silent reflux, as i later discovered, i had no symptoms and no awareness that anything was a problem.

My current GP says there is no automatic relationship with how large the patch is and dysplacia.

I have copd as well as bronchiectasis which is a condition of the lungs made worse by post nasal drip reaching the lungs, and i have a lot of that at present.

After the cyst was removed i started on 20 omeprazole, moving to 30 lansoprozole (cant remember why).  This was put up to 60 lansoprozole during a lung infection. It is very difficult to manage the combination of reflux with lung disease where there are multiple infections requiring steroids and antibiotics as both make reflux much worse.

It take magnesium and Vit D supplements to overcome malabsorption - last blood test showed Vit D within as fairly high within the "normal" range.

I wont write more now as my laptop is threatening to wipe this - its happened before.

Thanks again for your help and wishing you good help.

ps, any info on having the nissen alongside barretts would be appreciated - i had thought this wasnt possible.

Wishing you good HEALTH!

"Full column reflux" (ie reflux travelling the full length of the oesohagus) can breach the upper oesophageal spincter ("extra-oesophageal reflux" also known as LPR) and cause damage to the respiratory system including bronchiectasis.

You may read about that here: https://sites.google.com/site/downwithacid/home/reflux/reflux-reduction/lpr

You may read my blog of having the fundoplication here: https://sites.google.com/site/robichris/barretts#TOC-The-Laparoscopic-Nissen-Fundoplication-operation

Unfortunately my wrap came loose following 5 hours of violent retching from norovirus and I've since had it repaired with a Collis-Nissen which is more likely to remain in place.

So sorry you had to have repeat surgery to repair the Nissen.

Yes, ive been told that LPR is implicated in bronchiectasis.

Besides the barretts, the symptoms i have are extreme post nasal drip, occasional choking, chronic cough at regular intervals during the day nd bring up mucus.  No regurgitation, no bad taste in mouth, no globus and no difficulty swallowing.

Can you tell me how they monitor your barretts when the stomach is wrapped around the oesophagus? (that's if ive understood the procedure right).  

Ive had quick look at your blog and the BOC site, good this exists and i will be checking it out more in the next few days.

Many thanks.

Sorry you're having such a hard time with the respiratory effects. It may be worth while discussing the fundoplication.

In operation wraps the top part of the stomach (the fundus) around the base of the oesophagus to tighten up the sphincter. (They also repair your hiatus hernia at the same time.)

Swallowing may not be so easy initially while there is scar tissue but thereafter no problem so an endoscope can pass through just as easily.

I'm due my next scope in the next few weeks. I don't expect there to be any change.

I understand that its wrapped around the base of the oesophagus, but doesnt that cover up the barretts?

How far up the oesophagus does the wrap go, e.g. in centimetres?

Repairing my sliding HH would be great but doesnt there still have to be a bigger hole than normal to allow the top part of the stomach to go through it?

Hope your scope goes well - you sound like you're pretty chilled about it.

Thanks for all your support.

Think of the oesophagus like a rubber tube, softer than a hosepipe, more like a bicycle inner tube, that runs from the back of the throat through the thorax  Food boluses are pushed along this (also aided by gravity) by muscles squeezing the tube above the bolus.

At the diaphragm, it passes through a hole (the "hiatus") and immediately joins with the stomach at the oesophago-gastric junction (OGJ), sitting in the top of the abdominal cavity..

A hiatus hernia is when some of the stomach has forced its way up through the hiatus into the thorax which can impede the action of the muscles of the lower oesophageal sphincter facilitating reflux.

In a fundop0lication operation, first of all the herniated stomach is pulled back below the diaphragm. The shape of the stomach means the oesophagus doesn't enter at the very top but a little way down the right side. It is the bit of the stomach above and to the left of the OGJ that is taken and wrapped around the outside of the oesophagus between the diaphragm and the OGJ. (You will see an illustration on the Down With Acid site on reflux-reduction / fundoplication page.)

The effect is to pinch the tube tightly to reduce any reflux.

The Barrett's cells are on the inside of the tube so are unaffected by the external wrap.

Usually it is possible for sufficient length of oesophagus to be available between the diaphragm and OGJ for the wrap. If not, the oesophagus can be effectively lengthened using the Collis procedure (cutting the stomach to form an extended oesophagus) to enable a better wrap.

All the best,

Chris Robinson (chairman Barrett's Wessex patient support charity)

Annoying auto emoji has changed the end of bracket and coma above into a winking smiley!

Thanks so much Barrett.