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Sm12
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Quote Sm12 Replybullet Topic: Ppis and Barretts
    Posted: 06†Apr†2019 at 11:17am
Hi new member here had an endoscopy last year which showed grade 1 esophagitis and Barretts wasnít mentioned, can they tell if Barretts is present or not if thereís inflammation by the les?
Could it be possible to be under inflammation and do ppis actually stop Barretts and stricture if used long term? Ppis heal esophagitis apparently but do they stop Barretts happening. I ask as Iím in process of deciding if I am going to have the surgery, Thanks
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Quote chrisrob Replybullet Posted: 07†Apr†2019 at 12:16pm
Hi and welcome.

According to the Savary-Miller scale, grade 1 oesophagitis shows "single or multiple erosions on a single fold. Erosions may ooze fluids or just show redness." (There are 5 grades as defined here.)

Barrett's cells are usually visually discernable as slamon coloured patches, particularly at the 3 o'clock position, near the junction between the stomach and the oesophagus.
It is within those suspect areas biopsies would be taken; Barrett's can only be definitively diagnosed by a histopathologist examining biopsied cell samples.

Inflammation at the lower end of the oesophagus can make it difficult to identify Barrett's, particularly if there is bleeding.

PPIs will reduce acid, though not reflux: they just make it less damaging. With reduced acid, the oesophagitis will be permitted to heal. Barrett's cells are produced by the body as an "armour plating" to protect against acid erosion. Strictures may be the body attempting to reduce reflux.
There are many factors to the development of Barrett's which we are gradually discovering. The most obvious requirement is acid + bile + reflux (as described here) but genetic factors also play a part as well as age, sex, body build etc.

What surgery are you contemplating? I'm guessing a fundoplication? I had that 11 years ago - for me it was the best thing I ever did.
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Quote Sm12 Replybullet Posted: 07†Apr†2019 at 12:59pm
Thanks for reply, I think you are right with the genetic factor my father and nan had same problems. Yes Iím thinking about the Nissen Fundoplication think thereís no other options really tried all ppis for years help a little with heartburn but not extra oesophageal symptoms . The change in anatomy and lack of vomiting scares me tho, and losing too much weight after. Also duration of it lasting as Iím 43.
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Quote chrisrob Replybullet Posted: 07†Apr†2019 at 5:06pm
I was first offered fundoplication in 1994. Then, although keyhole surgery had been introduced for it, it would have been open surgery and I was too scared.
When I eventually had in in 2008, I was desperate enough to have tried anything. But it was a breeze. Forget the scaremongering about not being able to burp or vomit - most people can, though some need the scar tissue to heal first. I actually burped OK before I left hospital.
You may read my story and a number of others' on the Barrett's Wessex website, here.

And, losing weight? I lost 20 lbs - which is about the same as many others have reported.
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Quote Sm12 Replybullet Posted: 08†Apr†2019 at 1:45pm
Thanks chrisrob think Iíll have to give it a go maybe try put half stone on before having it done. Another question I have is recently an ent done a laryngoscopy to check vocal chords and he said they were fine no redness, moving fine but any idea why I still struggle I intermittently with voice he mentioned voice therapy but seems like Iím just wasting money all time seeing these different specialists looking for answers. Can the lpr symptoms affect voice but show no redness or inflammation?

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Quote chrisrob Replybullet Posted: 09†Apr†2019 at 11:43am
Certainly LPR (Extra-Oesophageal Reflux) can affect the voice box. As it attacks from the "underside", I guess redness is not visible as if it were from infection from above?
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Quote Sm12 Replybullet Posted: 12†Apr†2019 at 11:08am
Thanks my other main symptom is my breathing hasnít been great all the time lately, sometimes heavy seem to notice it more after eating not sure if thatís a psychological thing but did you have any problems like that before your op and weíre they fixed along with the hoarseness?
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Quote chrisrob Replybullet Posted: 12†Apr†2019 at 11:56am
Extra-oesophageal reflux can certainly affect the lungs, as described in this chapter of Down With Acid.

I was tested (negatively) for asthma. A number of refluxers are told they have asthma (though they mainly don't). Our Barrett's Essex co-ordinator has serious lung / breathing issues and damage caused by micro-aspiration of refluxate.

Even after my op, my wife tells me sometimes, after eating, I'm wheezing.
A year ago, I had lung function tests at the hospital. I had a spell where I was tired constantly and concerned it could be due to lung damage. I was told my lung function was 110% of what would be expected of a person of my age. The pulmonologist said he'd be surprised if there wasn't some damage from a lifetime of reflux but it wasn't affecting my breathing.
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Quote Sm12 Replybullet Posted: 12†Apr†2019 at 12:04pm
Thanks chris, how long do fundoplications usually last? Or is that a how longs a piece of string question
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Quote chrisrob Replybullet Posted: 12†Apr†2019 at 12:21pm
Longevity of fundoplication nowadays is usually quite good if performed by a good surgeon - but you usually get who you get with NHS.

My first fundo (described here) was actually performed by a newly qualified surgeon though it lasted well for 5 years but came loose following 5 hours violent retching due to norovirus. I knew it probably wouldn't survive the internal gymnastics that was going on.
My revision 5 years ago used a more permanent Collis-Nissen procedure whereby the oesophagus is first effectively lengthened by resectioning of the stomach to provide a larger space for a better wrap. It was performed by a good surgeon at Southampton and, at my last scope, a year ago, I was told it was still intact - as I'd expect.

A paper published in 2015,
20 years later: laparoscopic fundoplication durability, found, "Long-term results from the early experience with LF are excellent with 94% of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18% required surgical revision surgery to maintain their results."
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