Long term Acid Reflux

Hi all,

I have suffered from acid reflux since my mid twenties - I am now sixty five.

Over the years I have had to regularly increase the dose of acid inhibitors - I started on Omaprezole, then Lansoprazole and am now on Pantoprazole 40mg twice daily plus Peptac liquid at night and usually sleep in a semi sitting position.

I was also dignosed with Barrat's Oesophagus about eight years ago, but have not had another endoscopy for over five years now.

I understand there is an op available to repair (replace?) the sphincter, but my GP has always dismissed this - is it something I should be pressing for?

Thanks for any advice you can offer.

3 Replies

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  • Hi Chalkie

    If you have Barrett's Oesophagus you should be receiving regular surveillance scopes.

    I'm assuming you have no dysplasia?

    If you have short segment (< 3cm) non-dysplastic Barrett's you should be surveilled wvery 3-5 years under the latest guidelines. For longer segments that's 2-3 years. The latest guidelines may be viewed here: sites.google.com/site/barre...

    Omeprazole, Lansoprazole and Pantoprazole are all Proton Pump Inhibitors and are all as good as each other (though some people tolerate one more than another). 20mg omeprazole, 30mg lansoprazole and 40 mg pantoprazole are all equivalent (low or maintenance) doses. If they are not working sufficiently, discuss with your doctor doubling the dose. (I was on 80mg omeprazole prior to anti reflux surgery).

    But do see your doctor and ask for a referral for another scope to ensure things haven't progressed.

    The anti-reflux operation is the Nissen fundoplication. This worked for me but may not be suitable for everyone. If you get a referral, you can ask your consultant about it.

    Cheers

    Chris

  • The latest advice about managing Barrett's Oesophagus from the British Society of Gastroenterology is that patients like yourself are monitored according to the risk and the details of their Barrett's. Usually the interval between endoscopies is something like 2 - 3 years, sometimes longer, so you are probably overdue for a check up.

    As you may already know, it all depends on whether the results of the endoscopy find dysplasia or not. This is divided into low grade and high grade dysplasia. If there is dysplasia, then there is now the possibility of radio frequency ablation treatment. The details of the centres offering this treatment are on actionagainstheartburn.org.uk Basically the treatment removes the first layer of the lining of the oesophagus and removes the rogue cells. These are not cancer cells; it is like a pre-cursor condition.

    The risk of Barrett's Oesophagus turning into adenocarcinoma are about 0.33% - 0.5% per patient year, which is low, but this is the risk for any one year and it has an element of progressiveness. The longer you have had Barrett's, and the more severe your reflux, the higher the chances of it eventually developing into adenocarcinoma. The advice, based from the UK Barrett's Oesophagus registry about lifetime risk is:

    'People aged 30 years with newly - developed Barrett’s Oesophagus may have a risk of 11-25% of developing adenocarcinoma before they reach the age of 80 but there are many variables to take into account'.

    So I think that the first thing to do is to ask for another endoscopy, something that would be doubly important if you felt that your condition was changing or not. The biopsies should be taken every 2cms and in each quadrant according to the proper protocols, but this may not always happen so diligently. Some endoscopy systems are much better these days with use of special light sources to show up areas likely to be most at risk.

    If the endoscopy does not show any dysplasia at all there is no need to worry. If you have high grade dysplasia then you should automatically get treated. If you have low grade dysplasia then radio frequency ablation may well be a good preventive option for you - the results of this relatively new treatment look very promising so far.

    In so far as the lower oesphageal sphincter is concerned, there is a device called Linx londonreflux.com/index.php/...

    which consists of a magnetic bracelet that holds the sphincter valve closed against the reflux, but is flexible enough to allow food etc to pass through. There have only been a few operations so far to fit this device, and they are really intended for persistent reflux sufferers for whom other routes such as medication are not helping. The only surgeons I know who are involved with this device are Mr Majid Hashemi at University College hospital, London, and Mr Ken Park in Aberdeen. I do not know how you would fit in to their criteria, but you might discuss a referral with your GP.

    In one sense it is easier to do nothing and simply continue as you are; anything else you do will involve some fine judgements, medical procedures and some discomfort. But with your long term history of reflux, and the really serious consequences of cancer possibly developing at some time in the future (but maybe not) and the major surgery that would involve, I think you would be sensible to ask your GP to be referred for a thorough assessment by a specialist.

  • Hi Chalkie

    I know all about acid reflux! You may well find my previous post in the earlier messages but to summerise I had reflux for many years and in 1990 I had an endoscopy which showed Barrett's . I then took Pantoprozle at 20mg rising to 40 mg which controlled it very well. So sorry to hear it hasn't been as effective for you.

    What would concern me more is that I have been monitored by endoscopy every year, and the six monthly when abnormalities were found. Last October I was told that a nodule showed cancer so luckily as it was very early I have been having treatment at UCHL where. They removed the cancer and some dysplasia and I have has RF ablation to remove the Barrett's . I return in September and if all the Barrett's has reverted to normal I will be put on Three monthly surveillance.

    So my concern would be the lack of endoscopy and biopsies , push to get referred, UCHL is wonderful and although it means trips to London, assuming you are not there, it has been well worth it for me.

    As for repairing the sphincter I can't comment but again a. Referral to a specialist seems a must.

    All the best, hope you get it all sorted.

    Bob

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