Barrett Esophagus Support Group

After having my gallbladder out last December, I have had continued severe pain in my upper middle abdomen. I had a colonoscopy and endoscopy at the beginning of may, in which the GI doctor found inflammation in my esophagus and stomach, and bile pooling in my stomach, and I was told I have GERD.(I have no symptoms of heart burn so I was surprised!).

Pathology reports from the biopsies showed Barrett's esophagus, but the GI doc said he didn't feel that was accurate because of the inflammation.

I was put on omeprazole and carafate and was supposed to take those for 3 weeks and then call back and give them an update. Basically what I understood was that if the medication seemed to be helping the abdominal pain, we would just do another endoscopy and recheck for Barrett's.

If the medications did not help the pain, then he wanted to do further testing.

I called back on thursday after being on the medications for 3 weeks to give the update. I let the nurse know that the abdominal pain has not gone away, and I also have a couple new symptoms that have just begin, feeling like food is stuck right under my collarbone and a general strange feeling in my throat and chest, kind of like a tightness.

She called me back and told me that I was being referred to another GI to have an endoscopic ultrasound done. After talking with her, I was understanding they would do the EUS and rebiopsy for Barrett's and basically just "get a more detailed look". But then later in the day she called me back and said she talked to my GI some more, and they may or may not rebiopsy for Barrett's esophagus.

Later, of course once the office is closed and I can't call with questions, I started wondering why they would be doing the EUS, and what they are looking for if not rechecking for Barrett's?

Would this test be the test used to look for bile duct stones? At one point we discussed doing a test to look for a bile duct stone, although I did have an ultrasound done to look for that and they did not find any.

Hi,

I'm not a doctor so cannot give definitive answers but this is how I see it.

Firstly, I, too, had a cholecystectomy (gall bladder removal) after having experienced horrendous abdominal (or even abdominable) pain and some months later experienced the same pain for a couple of hours but subsided just as my wife was getting ready to drive me to the hospital. Speaking with a consultant gastroenterologist friend later, he suggested it had been a stone formed in the bile duct.

(A long account of my hospitalisation for cholecystectomy may be read here: https://sites.google.com/site/robichris/barretts/ cholecystectomy .)

I am confused as to why your GI doc is questioning the pathology. Although visually it may be difficult to distinguish between Barrett's metaplasia and esophagitis, biopsies are usually definitive. Through a microscope, squamous cells look like flat plates lying on top of each other whilst metaplasia looks like columns of cells stacked on end.

The "Lump in the throat" type symptoms you describe are associated with the GERD. It is known as globus pharyngis if you want to look it up.

Not everyone experiences an acid sensation with GERD so many don't realise they have it. But the presence of the inflammation, and the diagnosis of Barrett's, confirms you have.

Your ultrasound may have missed small stones in the ducts that led to your gall bladder. An EUS may spot them - or identify some other cause of your "abdominable" pain.

Meanwhile your omeprazole should reduce the production of stomach acid whilst the sucralfate protects the esophagus from acid attack and the esophageal inflammation should subside.

Hopefully you'll get your further investigations soon which will lead to your problem being solved.

Let us know how you get on.

All the best

Chris

Post edited by: robichris, at: 06/04/2012 02:11 AM

Chris,

I am confused why he is questioning the pathology report as well! And now I am even more confused that the nurse said "they may or may not take another biopsy to check for Barrett's". If he is questioning it, and I am having an endoscopic ultrasound anyway, we wouldn't they biopsy again!? It's a little frustrating!

I am also wondering, what is the "GERD diet"? He did not talk to me at all about what I should or shouldn't eat, but I have seen on this forum people following a specific diet for GERD.

Thanks for all your information and for sharing your story Chris, I went to your site and read about your gallbladder removal and about the surgery for Barrett's as well.

I will update after the endoscopic ultrasound. I am almost hoping they do find a bile duct stone so I know what is causing this awful pain since the medications aren't helping!

What is "GERD diet"?

Some foods make us salivate just looking at them. The stomach can react similarly producing acid in readiness to start dissolving certain elements from food we are about to eat.

How we react to food differs from person to person. It may be something to do with memories we have when we met particular foods for the first time.

There is no one special GERD diet - you may have to discover your own.

Keep a food diary and see which foods cause you the most problems. These are your "trigger foods". Trigger foods vary from person to person but are likely to include fatty foods which take longer to digest and move slower through the system. Spicy and acidic foods may appear an obvious candidate except that often when the stomach knows it is to receive acid food, it may be stimulated to produce less acid - the important thing being how acidic is it after receipt of the food: the "acid ash". Caffeine and alcohol may stimulate acid production whilst also relaxing the lower esophageal sphincter etc.

Foods that are normally found to be good include fresh fruits and vegetables. They are rich in fiber which helps the progress of the food through the digestive canal. However, citrus fruits, tomatoes and onions can cause problems in some people.

Although some consider milk as a harmless, soothing drink to calm an acidic environment, it is actually a food containing fat that can stimulate production of excess acid.

Searching on-line for a dietary answer to GERD can produce links to numerous sites where charlatans attempt to make money from the gullible telling them they have a natural cure for $xxx. In exchange for your money, they'll tell you to eat apples.

This site: http://heartburn.about.com/od/goodfoodsbadfoods/tp/Acid- Reflux-Diet.htm does provide some sound advice, however.

But the bottom line is, you'll need to experiment to find what is comfortable for you.

All the best,

Chris

Post edited by: robichris, at: 06/05/2012 09:13 AM