Oesophageal Patients Association
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My endoscopy report (for the more technical amongst u)

Hi ..

im with consultant next 26jan18. However i got this endosc report and it contains a couple of items i wldnt mind a heads up on should anyone know so that for next apptmt im forearmed/forewarned. Apologies its written reverse chronology diary style. Much appreciate any help. Good health and merry christmas to all. G

Summary/background .. get reflux but improving. No C. Worried about progression to barretts. Got oesoph narrowing due to stricture. Had HH nissen fundo 360 op 6sep17. Just had barium + endosc/stretch which have raised some qs. Generally fit/healthy male aged 60.

Diary/details .........

At 18dec17.

Lot of soreness after endosc/stretch 12dec .. felt he'd really had a play around down there. But the goodnews is .. at the mo .. i dont appear to be getting reflux. However my food seems to be taking ages to go down .. somethings not right. Im hoping that the endosc/stretch session had caused plenty of inflammation. I tried to eat normally plus after endosc (to test stretch) but now reverted to soft food diet to see if a healing period required and improves digestion similar to post HH op diet.

Since HH op .. 6sep17 .. I get alot of air/pressure in my stomach. I believe it was this pressure that was pushing reflux up. Pre bed ive taken to doin 5-10mins of gentle floor exercise to reduce that stonach pressure and burp up any excess air pre sleep. This helps.

12dec17 had sedated endosc at guys. On basis of barium results consultant decided to give me 20mm stretch (had one a year earlier). The thinking is that whilst food backing up my oesoph will always be dilated so need a stretch to enable food to pass.

Endoscopy report reads ... Severely dilated oesoph with liquid food residue. Cobblestone appearance of lower oesophageal mucosa ; no oesophagitis. Some slippage of fundoplication on retro-flexion - ocj dilated to 20mm. Solid food residue in stomach, rest of stomach, pylorus and duodenum normal. Diagnosis .. stricture in oesoph, delayed gastric emptying. Recommendation .. may need revision surgery.

With respect to the report

.. Severely dilated oesoph with liquid food residue; dilation known .. obviously some back up + id been veggie juice only 2 days prior.

.. Cobblestone appearance of lower oesophageal mucosa ; Anyone explain this one. Immed i thought we are on our way to barrets but consultant said no (to keep me hapoy??). Would like more info on this pks.

.. no oesophagitis. I take this to mean that general state of oesoph lining not bad .. ie no evid of reflux burning so i was well pleased. Thats interesting cos in morning i feel i get reflux. Consultants view was he believed this reflux was not acid from stomach but the fermented food residue coming up.

.. Some slippage of fundoplication on retro-flexion - ocj dilated to 20mm. No comment.

.. Solid food residue in stomach. Whats this?? Its new. Consultant said it may be to do with nerve damage in op that wld repair with time. More info pls.

.. rest of stomach, pylorus and duodenum normal. No comment .. sounds ok.

.. stricture in oesoph .. no comment .. this is a known.

.. delayed gastric emptying. Believe related to solid food residue item above. More info pls.

.. Recommendation .. may need revision surgery. Im not sure hrre only to say Pre endosc consultant felt that my reflux cld be due to nissen wrap being too tight.

11th december 17 . Barium at stThoms. Could see i still had oesoph narrowing and food backing up. Also cos of baggy oesoph there was a spot in oesoph where food residue remained.

Prior to 11dec17

Still experiencing reflux but 5 to 6hrs into sleep and it appears to relate to when i turn in bed (elevated) as if pressure pushing it up.

Your comments appreciated.

Merry Christmas

Gary

2 Replies
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The Nissan Fundoplication 360 degrees created a valve effect to stop reflux rising; and it should allow food to progress down to the stomach. A 360 degree wrap is not necessarily normal for conditions where there are motility problems (eg achalasia) where they sometimes to a 120 degree wrap, and there are alternatives, but there would have been a conscious decision and good reason to do the surgery this way. This is a technical issue above my head, but it might be that the wrap is on the tight side, and there may be some trapped wind that does not get released upwards - you will know of this is OK if you can burp all right. It sounds like you have had some problems here?

Sometimes surgery can affect the way that the nerves react and control the digestion muscles system. And sometimes there is swelling / scar tissue that takes time to settle down after surgery. And after a stretch there can be a reaction with extra reflux for a while.

Barrett's is normally visible because of the columns of changed colour in the oesophageal lining. It is good news that there is no apparent oesophagitis, which is a general term for irritation / soreness of the oesophagus and often caused by acid reflux.

There is a cobblestone effect for some conditions like Crohn's disease but it is dangerous to speculate; if the doctor thought that you had this they would have told you I imagine. This is a good reason for always interpreting these technical medical reports with a qualified doctor on hand.

If your oesophagus is still 'baggy' it may explain why food does not go straight down towards the lower oesophageal sphincter into your stomach, but in that case they would probably have noticed food residue and the barium swallow test would probably illustrate what is / is not happening.

I think you are sensible to revert to soft food and to take things that would soothe your oesophagus.

So one issue is how your system can be treated so that the stricture you mention does not stop you swallowing as efficiently as possible, particularly in the area around the lower oesophageal sphincter and the Nissan fundoplication. It is not a good thing for food to back up because the weight of it can cause the oesophagus to sag. There would be some foods to avoid like rice, bread and anything that congeals and solidifies before going into your stomach. Things with skins like tomatoes, or with a stringy texture might be a problem as well.

The second issue is how serious the change is in the appearance of the lining (the cobblestone effect). I would feel inclined to ring the secretary / specialist nurse in advance of your appointment and ask if they have any advice about this.

Finally it would be worth asking to check whether there is any sign of infection in the bacteria in your digestive system. There is no particular reason to think so, but it would be reassuring to have that ruled out if possible.

There is a fair chance that if you take things carefully, things might gradually improve by the time of your appointment. I certainly hope so, and hope you have a good Christmas.

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Thanks everso much for that Alan. Much appreciated Kind regards and nerry christmas to you and your family. Cheers mate.

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