Oesophageal Patients Association
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Barratts Oesophagus

Hi, I am new on here. My son 33ys has just been diagnosed with Barratts Esophagus. Determined by cell changes in the esophagus tissue. Which I gather is a protective measure of the body to protect the esophagus. And Hiatus Hernia.

I obviously am extremely worried about him. He has never been a great eater of vegetables other than starchy root veg like carrots potatoes sweet potatoes and parsnips.

I do feel he has a gluten issue going on as runs in the family, so I don't want to encourage him to eat more bread and grain based products.

But can anyone advise a good diet/ foods that may help?

Prime objective is to get his oesophagus tissue to heal but I know from learning about Functional Medicine clinicians that PPI's/ Acid blocking drugs are not conducive to health and cause Thyroid issues and stop absorption of vitamins and minerals.

Has anyone used Aloe Vera as an alternative ? Anti inflammatory supplements like Curcumin, CBD oil? Anything else?

Great Lakes Collagen - noteably an Intestinal Lining/Leaky Gut healer so supports growth of digestive system tissue, I thought may help. Has anyone tried?

Also digestive enzymes to be taken with meal or would they inflame already inflame already inflamed tissue? I know cider vinegar as per Chris Kresser but that is impossible due to state of tissue at the moment.

The Hernia operation and ablation of the altered cells - any experience?

Any recommendations re Barratts Oesophagus doctors?

I am a distraught, worried parent. Any input would be so gratefully received. Thank you.

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Hi Lynne ...first of all DONT PANIC ! ....I was diagnosed with Barrett’s 2cm area last June and have been advised to take PPI ‘s eversince and all is fine. Presuming your son like myself is and has been very healthy fit , non smoker , keeps alcohol to a reasonable level ! ( I also have two sons that age so I know that isn’t always going to happen)! Doesn’t have a poor diet - then he is probably doing all he can other than taking the tablets. Have you researched or had Barrett’s explained? It IS very rare for anything nasty to develop from Barrett’s .As your son like everyone with these symptoms will now be kept usually under a 1-3 year surveillance having repeat Endoscopy depending upon NHS trust protocol for your area , then if anything arose it will be caught extremely early.

Speak to a GP for reassurance.....otherwise you will worry yourself silly over something that as I was told two weeks ago is highly unlikely.

I was however told by more than one Consultant the importance of taking PPI’s far outways any side affects ( of which so far I have none ) and speaking from having a husband 5 months post op from a IVOR LEWIS procedure for Ca Oesophagus ....I listened !!!!

Best wishes

Deb

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Thank you Debbiewallis for sussing me out and telling me not to Panic! which of course I am doing :( Thanks for your positivity :) Sorry for late reply I have not been on my laptop for a few days. So sorry that your husband is having to go through such trials, I hope he is healing day on day. x

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Does he sleep propped up using a wedge Pillow? That might help the reflux.

I am with Debbie on PPIs. It isn't clear that the side effects claimed are related solely to PPIs. They may be as much age related. I have heard many doctors say that however bad the side effects they outweigh the risk of not taking them.

Haward

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Thanks for your reply haward. Thanks for your suggestion, I think he does sometimes, don't think he has been getting a lot of sleep for the last months - his son was born 19 weeks ago. Worryingly lots of stress at work too his boss has just died - his family found him dead sitting on the sofa! There's always someone worse off.... But means Tom is working 24/7. I am sure you can feel my pessimistic tone. I know it won't help anyone x

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Hi Lynne. The wedge will reduce acid reflux. Maybe Gaviscon before sleeping would Help too, especially if he is stressed. Haward

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The Wedge? Is that a wedge to rise the bed/ or a pillow?

I have just looked gaviscon up - thank you. It says creates a barrier that floats on top of the food in stomach to prevent food mixed with acid rising. That sounds better than just a lowering acid med. Do you know perhaps how Gaviscon really works?

I am scared of acid lowering meds when lowering acid protocol is in contention these days. Many state short term use only to heal damage.

Many: low acid produced is the problem as food is not mixed with strong amounts of acid and therefore starts to ferment in stomach causing gas and so pressure on the sphincter causing reflux

And many say: ah it is too much acid being made. Which is NHS old view, but why would body create too much acid, and why would acid create reflux. How does too much acid cause the sphincter to allow acid/food back up. Food needs to be mixed effectively with high strong acid.

It seems to me, NHS acting on old view - acid burns, acid reflux is causing the issue, must be due to, too much acid. But to many practitioners that view no longer makes sense.

Also stomach acid is our first line of defence against pathogens - most not surviving the acid. So if we lower acid further we are leaving our selves open to parasitic and any infection, particularly C Difficule. Also food passing into the small intestine without being mixed with enough acid is not going to digest properly in the small intestine because not broken down to a good extent in the stomach which is why a draw back of PPIs is known to be vitamin and mineral deficiencies.

Gaviscon is that similar to taking rennies or indegestion tablets? re lowering acid? Not sure how it creates this raft on top of the food.

Thanks for your reply x

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I have also been diagnosed with 2cm Barretts Oesphogus and been told how important it is to take PPI's. I have been told we are the lucky ones being diagnosed with our Barrett's so we are being regularly monitored because there are thousands of people walking around who do not even know they have it. I am on a brilliant group on Facebook called Barrett's Esophagus Awareness run by Chris Robinson who is so positive and knowledgeable. I would highly recommend it.

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Thanks Karjade, I will check out the Facebook Group :)

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The best sources of advice are Barrett's Wessex sites.google.com/site/barre...

and actionagainstheartburn.org.uk

The lining of the oesophagus cannot cope with strong stomach acid because the cells are different from the stomach. This is why we feel the pain of heartburn, and the change of the cells tends to protect against that pain, as you correctly state.

The acidity of diet is probably not so important for the long term prevention of problems as the medication, as stomach acid really is quite strong and food has relatively little effect by comparison. Which is not to say that some food may cause digestion problems or irritation and worth avoiding for those reasons. But do not think that you can achieve an equivalent effect to PPI medication (like Omeprazole) by adjusting diet.

There may be a good case for treating the hiatus hernia surgically as the means for protecting against reflux.

More people die with Barrett's oesophagus than from it, but there is a cancer risk. Somebody with newly-developed Barrett's aged 30 may have a 12 - 25% risk of adenocarcinoma by the time they reach 80 years of age. The risk multiplies if there is dysplasia, and the only way to find this out is through an endoscopy and biopsies. So the management of Barrett's means regular endoscopies sometimes every 2 - 5 years, according to the risks calculated for each patient. If there is dysplasia, this can be addressed through radio frequency ablation (RFA), but RFA is not always available at each treatment centre.

One issue that is important is the trend to have dedicated endoscopy clinic lists where more time is spent monitoring each patient, rather than the quicker more generalised endoscopy process.

If the worst happens, and your son does develop adenocarcinoma, the chances are that this will then be diagnosed very early and at a stage when treatment will be successful and curative. This is exactly why we believe that diagnosing more people who have Barrett's is a key strategy to improving outcomes against oesophageal cancer.

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Thanks AlanM, I just feel very confused. Thank you for the links, I will look them up. Is there some test, do you know that determines if the cause of reflux and the flappy muscle (sorry not a great description - the tissue, that is supposed to prevent back wash of acid into the esophagus) is caused by too much or too little stomach acid?

I have had Rheumatoid Arthritis for 22yrs and with not wanting to have to take the disease modifying drugs have had to learn a lot. And in so doing, you can't help but come across info re other conditions and causal factors. I attend Functional Medicine Doctors and Clinicians conference presentations, albeit online. This is a burgeoning movement with a huge ground swell that is seen as the future of medicine. A conference infact has just been held last week in London, for health professionals/doctors/public.

Functional medicine practitioners find the root cause of the health issue and so hopefully resolve it. One of the practitioners who's work I have followed/books I have read has focused over the years a lot on Acid Reflux/GERD. He states much more often than not the condition is caused by too little stomach acid rather than too much! Chris Kresser has written an ebook on the subject, freely available online. Revolutionary insight but all functional medicine docs agree and so the PPI's are not the route to take.

Perhaps they should be short term to allow healing of the tissue - I have no idea, I need someone to take my hand and talk me through this. But there is no one in this country yet, well if there are, they are like money trees!

I have learned too much in supporting my own health that now I see failings in the NHS and private mainstream and find it difficult to trust. I know for a fact that with the Gluten Scenario, NHS testing is abysmal and that is not in contention with 70% false negatives. Far advanced testing is now available but v expensive but proves beyond doubt how poor the current NHS testing is.

22 years ago I mentioned to my Rheumatologist and GP about the influence of diet and intestinal permeability (I was well read even then) They both laughed at me and said there is no such thing. 19 yrs later the same rheumatologist now Professor said to me that I should meet Gastroenterologist Professor David Sanders at the same hospital. She took my hand and said, 'he thinks just like you do. Seriously, he has publised papers on intestinal permeability, resulting autoimmune disease and Non Coeliac Gluten Sensitivity. He has won prizes across Europe for his work and to be honest with you, the evidence is unequivical' I nearly fell off my chair. Professor Sanders wrote a book on the subject in 2016/17. Mainstream is so far behind cutting edge practice.

This experience makes me doubt and question everything and to be honest acid reflux and associated conditions is again one of the conditions that is a minefield

I was hoping that someone other than me may have heard of /followed functional medicine and come from a functional perspective.

I obviously need to trust the consultant/s but I just needed to explain to you all, the above so that you can appreciate how difficult this is for me. x

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There are tests for how much acid/bile is being refluxed. I believe that this is a hydrogen breath test, but there are also strips that you can buy over the counter that give a pH score. But yo have to be careful about interpretation. An endoscopy would tend to show whether acid was rising because of, say, a hiatus hernia.

The fact is that stomach acid is strong acid in a healthy digestive system. Sometimes the lower oesophageal sphincter is overcome because of obesity / pregnancy or posture and sometimes because of some condition that causes the stomach contents to rise through vomiting etc. So it is quite likely to be the result of what pressure the sphincter is put under, and how well it works, rather than acid levels in the stomach, that causes the problem, as far as I can see from a non-qualified perspective.

I think this might have partly answered your question?

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Thank you so much. My son was put on the 2wk cancer pathway for tests which amounted to colon camera investigation which was normal and the intestinal esophagus endoscopy. He was then discharged from the pathway.

Following this v recent endoscopy was told he has a hiatus hernia and that his esophagus is very inflamed and cell changes indicated Barratts. He was called to go for an app yesterday and told that his esophagus tissue on the recent endoscopy is so inflamed that identification of cells wasn't possible.

He is thin but has smoked (outside the home) and then because getting married he stopped and used a vapour kit - which will be just as harmful, probably more so. Then when his baby was expected and born he stopped vaping completely.

So possibly it seems this habit and the now identified hiatus hernia is causal?

I remember Functional Medical Clinician Chris Kresser speaking of the sphincter being the problem with reflux. And this weak sphincter was caused by too little acid being produced? Because of the food being mixed with too little acid in the stomach and therefore not breaking down adequately creating fermenting gas that in turn puts pressure on the sphincter?

I can't quite remember, I will have to dig into research again.

Posture, sofa when eating - doesn't seem to sit at the dining table now he has his own home - could well be a factor

Also he does have a fused vertebrae at the top of spine from a childhood accident - this could prevent normal nervous system messaging /vagus nerve or other pathways affecting production of acid/digestive system working correctly. A friend on a facebk health group who has a hiatus hernia sees an Osteopath for massage which helps.

Have you heard of anyone trying this?

Thank you so much for your reply - the tests and refocusing my thoughts on the sphincter issue. So that would explain why smaller meals are helpful as not as much gas creating pressure :)

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I can quite imagine that inflammation would make further tests very difficult if not impossible. Giving the affected place respite from the reflux can let it recover, and sometimes this can be achieved with Gaviscon Advance in addition to any other medication.

Smoking can relax the lower oesophageal sphincter and it is this mechanism that seems to contribute the cause (notwithstanding the other health risks from smoking). Relaxing the sphincter will tend to increase the risk of reflux. There are some people who believe that fermentation within the digestive system will create the upward pressure, but it really is something that has to be diagnosed for each patient.

I have not heard of the sphincter being relaxed because of insufficient exposure to acid before, but would not wish to comment on that possibility without being qualified. The sphincter is connected to the muscles of the diaphragm so it is possible that massage may have an effect. But it would again depend on how serious the hiatus hernia is. I have not heard of anyone trying it before as such.

I think I would be inclined to listen carefully to what the doctors are saying. The first thing seems to be to try and get the inflammation reduced and then look at longer term issues later.

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Bless you for your replies and concern. I really do appreciate it. Your open minded knowledge and approach is great to relate to. Thanks for the info re Gaviscon Advance. I totally agree with you re the inflammation needing to be priority and I suppose repair of the diagnosed hiatus hernia by operation.

I also am hoping the company Fushi.co. uk product: Organic Aloe Vera Juice can help heal the tissue of the esophagus, if taken before meals and anytime I believe. This also is rich in many vitamins and minerals as an added bonus for repair. And then Gaviscon Advanced perhaps before bed when issues may start/be worse.

I have also read somewhere that tissue / muscle strength - thinking the sphincter. Needs nutrients to promote such strength - such as supplement Great Lakes Collagen/Gelatin. :)

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Hi Lynne,

ALL the above is really good advice, it's brilliant news they have picked up on it and it's being monitered. It's natural to be distraught, but knowing there is so muuch help out there will hopefully ease those worries ~ let us all know how he gets on xxxx

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Thanks lynnbibb. I am a worrier from my own experience with health issues. Please see my reply to Alan above. I am in a world of confusion right now but thanks for being so positive x

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Do please stick to evidence based medicine and avoid the anecdotal, quack cures - there are no magic substances which can work miracles.

If he follows the obviously sensible routine advice of no smoking, minimal alcohol, sufficient good quality sleep, weight control, reducing stress and cutting down on fried foods, red meat, five-a-day fruits and veg, etc etc then there is every likelihood that the Barretts will not progress. It cannot be reversed. The PPIs are a crucial part of this holding strategy, as are such measures as raising the bed head' to reduce night-time exposure. Any reduction in nutrient adsorption can be counteracted by supplementation.

The hiatus hernia is an area which requires specialist assessment and advice; is it of such severity that surgery, such as fundoplication, would be indicated?

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Thanks Gutless Wonder. I presume from your reply that you have learned that PPIs can cause nutrient absorption issues. Please would you detail what these may be so that I can makesure that Tom takes the relevant supplements - Thanks. I must admit that with PPIs I am worried about the infection of C Diff. I really appreciate your reply, thanks x

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Apologies for the delay in getting back to you. My own situation is of little or no relevance to Tom since I have had too much surgery!

This is the best I could do:-

healthunlocked.com/oesophag...

I don't believe that for anyone still in possession of the anatomy he was borne with, there is any need to get in a lather about supplements.

Despite having lost all my Oesophagus and part of my Stomach and Vagus nerve as well as the Gallbladder I still rely on the simple, manageable broad-brush precaution of taking one pill once a day - this contains an high proportion of the NRV of 25 ingredients. (Centrum Advance 50+) . It's not expensive and even if I were overdosing on any one ingredient it is most unlikely to do any harm.

I should state that I have never taken PPI's, out of concern for raising my intestinal pH balance too far. Even so I still experienced enough loss of skeletal calcium as to suffer three collapsed vertebrae.

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Thank you so much for your reply/links and personal experience info. You really have gone through so much and I can only hope that you will be rewarded with better health for putting yourself out there to help others - thank you.

His consultant has put Tom on acid blockers rather than PPIs saying gentler ! They block acid production from the parietal cells. I have no say in this but it is a short measure to enable healing of tissue so that at another endoscopy in around 6-8 weeks the health of the cells can be determined which they couldn't re inflammation.

I know re B12 issues that function of pareital cells is what is tested to determine absorption /malabsorption of B12. No one has said to Tom ensure you take sublingual B12 and folate or lets give you B12 injections whilst taking these Acid Blockers. !

Just like doctors don't mention, encourage or prescribe the taking of probiotics when prescribing antibiotics or undergoing anaesthesia

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