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Ulaman
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Quote Ulaman Replybullet Topic: Barett suspected on endoscopy, IM negative
    Posted: 10 Dec 2019 at 11:22am
Greetings from Finland!

First of all: Thanks everybody for contributing on this forum. I have been reading it ever since my scope and it has helped a ton with the anxiety.

I'm a 27 year old man. I've been having some reflux symptoms for the past 4-5 years, which are easily tamed with PPIs. I was scoped about a month ago and on endoscopy, there seemed to be a suspicious tongue of CLE. The biopsies however came back negative for intestinal metaplasia and dysplasia, but positive for "gastric heterotopia" and some light inflammation. My doctor doesn't recommend surveillance, as in Finland Barrett's is only diagnosed if there is IM. The usual interval between endoscopies is
5 years.

I'm a bit concerned however, as any columnar lined esophagus, with IM or not, is potentially dangerous according to some research and is regularly scoped in some countries. I'm getting a second opinion from a GERD specialist to figure out if I should go for another scope in some years, I could even do it privately if I'm not offered one by public healthcare. Given my relatively young age, I would really like to be on surveillance if there indeed is an elevated risk for cancer, as I would carry that risk for a quite long time.

A curious detail is that the pathologist diagnosed heterotopia instead of metaplasia. There seems to be a difference [1], and the former seems to be believed to be congenital and benign. However, I'm definitely not going to trust this on my own Google research. Also there is the possibility of sampling error and so on.

I guess I mostly just wanted to share my case. Any thoughts on getting another scope?

[1]: https://www.ncbi.nlm.nih.gov/pubmed/22198897

Edited by Ulaman - 10 Dec 2019 at 11:25am
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chrisrob
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Quote chrisrob Replybullet Posted: 11 Dec 2019 at 2:18pm
Hei ja tervetuloa,

(Sorry I don't actually speak Finnish.)
As you recognise, although CLE is recognised as Barrett's in some countries, in others, it has to be IM.

I imagine your suspect area is small as it is just described as a tongue.
Since most scopes show no change, the viability of regular scoping is questionable. If your Barrett's is going to mutate, you would more likely notice new symptoms that would make you return.
Although regular surveillance does provide some reassurance, even if you had scopes every year, you may be worried about changes at the 6 month period.

Heterotopia is an unusual diagnosis. You would have to ask the pathologist why he used that definition. It is more usually used if the condition is considered not to be from acid reflux but some genetic factor but if PPIs are helping, it does implicate the role of acid in your symptoms.


Edited by chrisrob - 11 Dec 2019 at 2:19pm
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Ulaman
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Quote Ulaman Replybullet Posted: 11 Dec 2019 at 6:36pm
Thanks for your reply Chris. I try to keep in mind that the risk for progression is small, gotta admit it's pretty hard though as Barrett's still feels pretty scary.

I'll post here what the GE says about my diagnosis in a week.
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