Oesophagitis

[MikeK]

My 35 old daughter is very stressed at present as she has had acid reflux for several months. Following referral by her GP she had an endoscopy in March and the result was Grade C Oesophagitis. She was put on 40mg Omeprazole which has not helped followed by Ranitiding 350mg which again has not helped either. Her concern is genuine as I had an oesophagectomy to remove a tumuor 2 years ago and also her Grandmother died from cancer of the oesophagus some 20 years ago. Has anyone had a similar experience and how serious is oesophagitis?

[Mark4]

I am sure your daughter will be fine but given the family history if she was my daughter I would try and get her on the list of an upper gi specialist for regular monitoring this question of yours is a good one and should be pointed at a specialist Upper GI surgeon or gastroenterologist . If necessary pay to see one privately it will cost £200 or so. Your GP should refer you NHS or private.

You should also ask for a referral to a genetics consultant given family history this would not I suspect be a problem and monitoring would follow from that.

[MikeK in reply to Mark4]

Many thanks Mark

Regards

Mike

[Hidden]

Oesophagitis is an overall term used for when the lining of the oesophagus gets irritated and inflamed. Very often medication like omeprazole sorts it out, but there can be a variety of causes and variations, and sometimes this process of diagnosis can take time. Grade C (they go from A to D) is towards the more serious end, but your daughter's problem seems to have developed within the last few months. There will probably be some food (eg spicy) and perhaps alcohol that she might need to stay away from. Sometimes it can be caused by medication for instance. Sometimes pregnancy or a hiatus hernia makes things worse. So at this stage it does sound like she really needs to work with the doctor to try and establish the underlying cause and to get it settled down. The details of the endoscopy report might give some useful details and will indicate whether she has Barrett's oesophagus or not.

Barrett's oesophagus is when the cells of the oesophagus start to change colour in columns because of the effect of the acid. This gives a low risk of developing adenocarcinoma, but the risk is higher if there is dysplasia present, which is when the cells start to change in a form of pre cancer. Somebody with newly developed Barrett's oesophagus aged 30 may have a risk of 11-25% of developing adenocarcinoma before the age of eighty. So the cancer risk is normally a long term thing.

There are some very rare cases of Barrett's oesophagus running through families but that is the exception rather than the rule. There are some genes that have been identified that might account for a percentage of the cancer risk, but the real issue at the moment is to resolve the reflux for your daughter. Stress and anxiety do not help the acid; but telling her not to worry is easier said than done especially with the family history. There may be a case for taking Gaviscon, which should not interfere with other medication and might give some relief.

There are higher doses of omeprazole that can be given quite normally, so the doctor might adjust the dose. The other thing to bear in mind is that it can make a difference as to when you take PPI pills like omeprazole. They are designed to be taken on an empty stomach; not doing so can reduce their effectiveness by 40%, according to the excellent gastroenterologist Anton Emanuel in an article in the Sunday Telegraph last weekend.

The really important thing is that she has had an endoscopy. I think the answer to your question is that oesophagitis without Barrett's Oesophagus is uncomfortable and distressing rather than posing a cancer risk as such, but that it is a cause for persisting with the doctor to reduce the problem; and asking for a referral to see a gastroenterologist if working with the GP to resolve things is not successful in the next couple of months.

[MikeK in reply to Hidden]

Many thanks Alan

Regards

Mike

[Hidden in reply to MikeK]

I was talking to somebody about this issue this morning, and she said that sometimes the oesophagitis can cause difficulties in establishing whether Barrett's Oesophagus is present or not. This is because the tissue can be inflamed I think. So the priority is still for the oesophagitis to be cleared up - and then , in due course when the oesophagitis has cleared up, there may need to be a further endoscopy to check on the Barrett's situation properly.

[MikeK in reply to Hidden]

Many thanks again Alan. She has been to see her GP today and a further appointment with a consultant is being arranged.

Regards

Mike

[JessMadge]

Is your daughter overweight MikeK? Because if she is, this may be the cause of her reflux - the valve at the top of the stomach is weak and if there is tummy fat pressing on the stomach, it can cause reflux.

[MikeK in reply to JessMadge]

Thanks for your post Jess but no she is very slim!!

Regards

Mike