Dysplasia.

[Lydia1960]

Can this condition be explained? The symptoms that suggest or lead to this? How serious this condition is and whether it indicates cancer or possibility of leading to this? Whether having grade two oesophagitis can lead onto dysplasia? How to prevent the development of this disease? Especially if you are suffering extreme stress, continuously? Can anyone shed light on this and how it is diagnosed and treated?

[Hidden]

Dysplasia means that there are changes to the cell structure of the part of the body involved, and these are detected under a microscope rather than felt as a symptom.

It is often split into low grade and high grade dysplasia, but the difference is technical. But thinking of this as a precursor condition, rather than cancer itself, low grade dysplasia may carry a risk of 5% of developing into oesophageal adenocarcinoma in the following 1-8 years; high grade dysplasia's equivalent risk is 50%.

The thinking is that prolonged exposure to reflux causes dysplasia, but whether this is certain or not i do not know.

Dysplasia is most commonly associates with Barrett's Oesophagus rather than oesophagitis. The endoscopy report would probably clarify the existence of Barrett's.

Stress might well increase reflux for some people and is worth addressing in its own right to improve health and well being. Making a direct connection between stress and cancer is probably a couple of jumps too far though.

[Lydia1960 in reply to Hidden]

Thank you for shedding light on this topic. So Barrett's Oesophagus has to be present before dysplasia develops? And, presumably, if Barrett's is present this would be revealed on a routine endoscopy procedure?

And are you suggesting that there is no known link between these two conditions and stress?

[Hidden in reply to Lydia1960]

As I understand it, Barrett's would be present before dysplasia develops, but I am not qualified, and do not know the technical answer as to whether it is possible to develop dysplasia without Barrett's already being there. This all relates to adenocarcinoma (70% of the UK oesophageal cancer cases); whether dysplasia occurs before, say, squamous cell carcinoma, I do not know. You can, for instance, get dysplasia in polyps as a precursor to colon cancer. Part of the problem is that diagnosis is too often made when the cancer itself has already developed.

An endoscopist can recognise visually the change in colour caused by Barrett's Oesophagus. Modern endoscopy instruments have different light sources to show up problems more clearly, but the real problem is that the dysplasia has to be ascertained by taking biopsies that are then analysed in the path lab. So taking the biopsy samples from the relevant part of the oesophagus is crucial; it is possible to miss them. Having a proper surveillance endoscopy where samples are taken every 2 cm in each quadrant (Seattle protocol) takes much longer than a routine endoscopy, which is why the enlightened hospitals are going in for specialist lists for these endoscopies. They do take longer.

The risk factors tend to be expressed as age and obesity (the extra body weight causing more upward pressure for reflux). I think that stress and related lifestyle matters might cause / increase reflux, but whether the extra stage of stress causing dysplasia can be regarded as a proven link within the medical research world I do not know, but Stress is included in a list of factors that can cause reflux in NHS Choices:

nhs.uk/Conditions/Gastroeso...

So it does come down to trying to prevent the causes of the potential harm of prolonged, severe reflux.

[Lydia1960 in reply to Hidden]

Bit of a concern that as I am having some symptoms which might, or not, be related to colon cancer. Just wondering would these polyps be found by an endoscopy which I had in January as was informed the only thing found was grade two oesophagitis? Is this related to colon cancer? Just read the part that dysplasia can be missed during an endscopy if no biopsy samples are taken. Would this be the case if it is related to colon cancer, especially if advance? Very worrying but need to know the bare facts. Are there any symptoms that are recognisable for dysplasia or colon cancer, especially advance? And do you know the survival chances of someone with that disease? Need to know..

[Hidden in reply to Lydia1960]

For the colon, the endoscope goes through from the other direction (your backside) ie a colonoscopy. For colon cancer, the symptoms include bleeding from the backside / blood in poo / change in bowel habit /unexplained weight loss.

You would not feel the polyps, but if you had a colonoscopy they would notice them and deal with them automatically.

Survival is heavily dependent on how early the cancers are diagnosed.

From all that you have written, I think I would simply concentrate on your oesophagitis; and try to deal with your stress levels by adopting some form of relaxation technique. It is generally the case that people who worry about cancer after having had initial investigations, like you, turn out not to have cancer, but I fully appreciate that each case is different. Being able to accept reassurance is also something of very great value, but easier said than done.

[Lydia1960 in reply to Hidden]

Spoke to a doctor today who suggested that the palpable colon in the left iliac fossa that the gastro specialist thought she could feel, which has led my mind towards the idea of colon cancer, was probably related to faeces in my stomach that the extra laxatives may have rid me of, so she suggested I make an appointment so she can examine my stomach to see if she can still feel the palpable colon. If not, then the extra laxatives have dealt with that, but if so, not sure what that would mean...?

Thank you for your insights. They are quite based on factual stuff rather than pure conjecture. And definitely learning how to relax in a stressful environment is going to be key to trying to preserve my physical health.. Really valuable insights...

[Hidden in reply to Lydia1960]

Sounds logical. If you have been constipated, there may have been various lumps still hanging around in different parts of your digestive tract. So it would have been a lump of faeces rather than a tumour that was felt.

Constipation can make you feel quite ill. Clearing your system of this would have made everything a whole lot better through your whole system. So that is good news.

Make sure that you drink plenty of water as that will help your system work well.

[Lydia1960 in reply to Hidden]

Great advice as usual. Thanks for that. And, yes, I must increase my water intake. That will surely improve my digestive system. Much appreciated....

[gutlesswonder in reply to Lydia1960]

If you can get going with the exercise (preferably walking) you should find that that will have a miraculous effect on your bowel habit and hence comfort level.

Live yogurts and vegetable fibre will not go amiss either.

[gutlesswonder]

Reflux Esophagitis

Prognosis and Predictive Factors

The natural course of gastroesophageal reflux disease (GERD) is variable, and treatment typically involves the use of acid suppressor drugs. Surgical intervention is required in patients with hiatal hernia or an incompetent lower esophageal sphincter (LES).

The nonerosive reflux disease is thought to be nonprogressive in its clinical course. Erosive esophagitis, however, can become complicated by the development of ulcers and formation of strictures due to fibrosis. About 10% of patients with symptomatic reflux develop Barrett esophagus, which is a precursor lesion for adenocarcinoma of the esophagus.

[Lydia1960]

That seems to be the best way to control this disease. Through exercise and trying to rid excess weight. So more effort should be placed on this. And also trying to curb the stress factors in my life. These are the factors that keep being mentioned so evidently these are the ones that I need to concentrate on. This will help keep possible developments and progression of this condition.