There is an article on acid reflux in todays daily mail on acid reflux that says that PPIs work for 90% of peaple and take the sting away,but acid is still going up into the gullet and injuring it. My understanding is that after our operation taking PPIs does help in giving us some protection on what remains our our gullet. If you have Barretts oesophagus you take PPIs to protect the oesophagus I would be interested to hear other comments on this.
Phil
The DM article doesn't sound right to me . My understanding is that PPI stop the production of acid .
I am not sure as I have not read the article yet but speaking from personal experience I take the maximum dose permissable of Ranitidine and Pantoprazole and STILL I get severe severe sporadic burning pain in my chest area and sometimes the acid actually seeps into my lungs if I happen to be sleeping or bending over at time of attack. In that respect the article MAY be right in that the acid production is NOT being stopped (in my personal experience that is) and more so I still experience severe pain from the acid travelling up my gullet and doing its damage.
PPIs do switch off the production of stomach acid, but this depends on the dose. They were originally developed for stomach ulcers etc rather than protecting the oesophagus, but nevertheless do a good job generally for that purpose as well. There are other stomach contents, like peptin, that may be involved in causing trouble for the oesophageal lining and think that PPIs may not touch this; nor do they combat bile, which is an alkali rather than an acid.
I am assuming that this is the article you mention:
dailymail.co.uk/health/arti...
I am sure that PPIs do have a protective effect overall, but it is also true that if you have, say, persistent heartburn and possibly Barrett's Oesophagus and the doctor prescribes PPIs, the symptoms will invariably decrease. But the best thing to do is for the PPIs to be stopped after 8 weeks, and the situation then reviewed. If the reflux has not stopped (allowing for a temporary bounce effect after stopping PPIs) then it is best to have a further investigation / endoscopy.
This will help to reach a definitive diagnosis of what is wrong. If this does not happen, and patients are on PPIs long term without having had an investigation / endoscopy etc then it would be fair to say that the PPIs may mask the underlying problem eg Barrett's Oesophagus and possible dysplasia and the early signs of developing adenocarcinoma might be missed.
I am at present undergoing treatment for Oesophagal cancer which was found at a very early stage and is being treated by endoscopial means.
I had very bad acid reflux in my 30s - I am 69 now - and at the time the doctor just advised anti acid products.
In 1999 a new GP sent me for an endoscopy and Barrett's was diagnosed. My Local Health board has a monitoring scheme in place for Barrett's so i had annual endoscopies and was on PPI at 20mg a day.
In early 2013 the endoscopy found some dysplasia and i was put on 40mg of PPIs and had 6 monthly endoscopies. In October 2013 the cancer was identified and i requested to be referred to UCHL as they carry out endoscopial treatment and ablation.
The cancer was only T1 so could be removed by EMR and a second visit removed some dysplasia.
Two weeks ago I had the ablation by RF and am just about back to normal but with some soreness still.
My acid reflux was always very painful but i do wonder if there is still some reflux which I don't feel even with the PPIs.
I must say that when I was given PPI first the effect was amazing as the very painful reflux disappeared immediately.
I assume that the damage done to my Oesophagus and the large section of Barrett's was what lead to the cancer, but would like to know a little more about possible "silent" reflux. I shall explore that with the team at UCHL.
I think the message from all this is that early diagnosis is essential and for Barrett's sufferers monitoring by endoscopy is essential if that is to be achieved.
You are absolutely right! This is exactly the message that we try and put over in Action Against Heartburn actionagainstheartburn.org.uk
The results from radio frequency ablation are very encouraging - and it is great to be treated for cancer without having an oesophagectomy.
The pain of heartburn seems to be caused by the reaction of the cells of the oesophagus to the stomach acid / contents. Gradually those cells become more like stomach and intestine cells that are designed to withstand the acid and that change in the cells has a sort of protective effect from the pain. Often people do describe heartburn that, after some years, goes away. That means that Barrett's Oesophagus has almost certainly become well established.
I believe that there are some people with adenocarcinoma who say that they have never felt heartburn. Whether this is because they have forgotten about it from years ago, or whether their bodies are different in some way I do not know.
There is a strong belief that having PPI medication long term, without an endoscopy to diagnose the underlying causes properly, can mask the symptoms of developing cancer.
Thank you Alan, I will try to spread the message as much as possible, and have been doing so already.
Since receiving my diagnosis I have discovered that at least 3 friends have Barrett's and only one is being monitored regularly, they are in other areas of the UK. One was so concerned he immediately requested an endoscopy.
I always had very severe pain from reflux, i have an haitus hernia so that does not help.
When i have completed the treatment whic should be soon i will try to find ways to publicise the condition and the need for survelance.
Interestingly my GP told me that in 2004 they nearly stopped the regular endoscopies and it was only through GP pressure that they were maintained, so my outcome could have been much much worse!
i had no indication of any advance in my condition only when the endoscopy showed some dysplasia was i concerned and then of course at six months the carcinoma. i guess by the time i would have been aware of the cancer it would have been too late fr the treatment I am receiving.
I must say that the treatment at UCHL is superb and Dr Haidry and Dr Lovet have been excellent.
Yes, they are both great. There have been guidelines on surveillance of Barrett's patients that have been issued by the British Society of Gastroenterology recently. They advocate assessing the risk for individual patients more carefully.
I think part of the reason for non surveillance is that the research publications tend to measure the risk of cancer by the risk per patient year (around 0.3% - 0.5%) which is small, but when you consider the lifetime risk over a good number of years, the risk becomes that much greater, and does rise very significantly once high grade dysplasia is involved. And the only way to find the dysplasia is through an endoscopy.
Yes I am aware of the new guidance and I understand that ablation has been accepted by NICE as a treatment.
As you say over time the risk increases, I had symptoms in the 1970s and it wasn't until i had an aware GP in 1999 that endoscopies began. I was showing onlr Barret's until early 2013 when high grade dysplasia was found and in October 2013 the carcenoma.
We need the same sort of survellance as that given to cervical cancer which is treated by laser at and early stage.
The ablation needs to be available at least when high grade dyspalsia is found and eventually when barrett's is found.
Regards
Bob
Hi Horsender,
As Alan says, Barrett's Oesophagus protects the oesophagus to a certain degree from acid attack and being less sensitive than the original squamous tissue, protects us from feeling the burning as well - though it may well continue to exist. But, apparently, upto 40% of those diagnosed with Barrett's report never having felt the heartburn symptoms.
I'm glad your cancer was found early enough to be treated and that you were able to undergo EMR and Radio Frequency Ablation rather than requiring oesophagectomy.
We do need to get the message out there to make others aware to reduce the number dying from this cancer that could be prevented with early diagnosis and surveillance.
All the best
Chris
As you say we must get the message out there as the latest stats showed only 15% of those diagnosed with oesaphagal cancer survive for 5 years or more.
With treatment available that is so much less drastic than complete removal of the oesaphagus we should be able to improve this a lot, early diagnosis is needed.
Thank you
Bob
