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From: satxweb on 29 Jan 2008 13:24
Hey guys/Howard,
As stated on another topic, I have Barrett's. I've taken pantaprozole
(PPI) for about 3 months now and it seems to work. Previously, I was
not on anything because I stopped without my doctors orders because I
felt good. Stuipd mistake, i know.

Anyhow, the acid reflux/burning sensation is gone, but on some days I
still get a "hint" of burn (like right now). The symptomps are not
completely gone, but it's definitely manageable. If I don't think
about it, the symptoms are gone. If I think about it, I can feel the
burning sensation. That's what I am talking about. Some nights it can
flare up uncomfortably, but for the most part it's under control.

Since I have Barrett's, do I need to be concerned about this or is it
common to feel some burning sensation every other day or so? In other
words, do the PPIs need to completely turn off the burning sensation
for me to not be alarmed? If not, then at what point do I alarm the
doctor?

I'm going to talk to my doc, but I figured maybe Howard would know
what I can expect to hear or do.

Thanks!
From: Howard McCollister on 29 Jan 2008 23:47
In article
<71027905-dc32-4173-adf5-b7001297b192(a)f10g2000hsf.googlegroups.com>,
satxweb(a)gmail.com wrote:

> Hey guys/Howard,
> As stated on another topic, I have Barrett's. I've taken pantaprozole
> (PPI) for about 3 months now and it seems to work. Previously, I was
> not on anything because I stopped without my doctors orders because I
> felt good. Stuipd mistake, i know.
>
> Anyhow, the acid reflux/burning sensation is gone, but on some days I
> still get a "hint" of burn (like right now). The symptomps are not
> completely gone, but it's definitely manageable. If I don't think
> about it, the symptoms are gone. If I think about it, I can feel the
> burning sensation. That's what I am talking about. Some nights it can
> flare up uncomfortably, but for the most part it's under control.
>
> Since I have Barrett's, do I need to be concerned about this or is it
> common to feel some burning sensation every other day or so? In other
> words, do the PPIs need to completely turn off the burning sensation
> for me to not be alarmed? If not, then at what point do I alarm the
> doctor?
>
> I'm going to talk to my doc, but I figured maybe Howard would know
> what I can expect to hear or do.
>
> Thanks!

PPI's don't stop reflux, they only change the nature of the refluxate.
Typically, "heartburn" is caused by acid. PPI's are effective at
shutting down acid, so they are good at controlling symptoms. However,
the alkaline secretions from the stomach and duodenum are at least as
damaging to the lower esophagus as acid is. So, PPI's may make you feel
better (and that is important) but you can't use your symptoms, or lack
of symptoms as a guide to whether or not you've stopped the progression
of Barrett's esophagus. There's only one way to stop Barrett's esophagus
and that is to stop the reflux. And there's only one way to stop the
reflux and that's with surgery. Also, you're going to have to continue
to watch the Barrett's. Surveillance EGD's with biopsies every 1-3 years
for the rest of your life. Wish I had better news, but Barrett's
esophagus at your age is serious business. THAT is some advanced GERD.

One consideration is ablation of the Barrett's tissue. Look at
http://barrx.com . This isn't likely to be of much help, however, unless
the reflux is stopped, and that can't be done with medicine.

HMc
From: satxweb on 31 Jan 2008 21:46
On Jan 29, 10:47 pm, Howard McCollister <nos...(a)nospam.net> wrote:
>
> PPI's don't stop reflux, they only change the nature of the refluxate.
> Typically, "heartburn" is caused by acid. PPI's are effective at
> shutting down acid, so they are good at controlling symptoms. However,
> the alkaline secretions from the stomach and duodenum are at least as
> damaging to the lower esophagus as acid is. So, PPI's may make you feel
> better (and that is important) but you can't use your symptoms, or lack
> of symptoms as a guide to whether or not you've stopped the progression
> ofBarrett'sesophagus. There's only one way to stopBarrett'sesophagus
> and that is to stop the reflux. And there's only one way to stop the
> reflux and that's with surgery. Also, you're going to have to continue
> to watch theBarrett's. Surveillance EGD's with biopsies every 1-3 years
> for the rest of your life. Wish I had better news, butBarrett's
> esophagus at your age is serious business. THAT is some advanced GERD.
>
> One consideration is ablation of theBarrett'stissue. Look athttp://barrx.com. This isn't likely to be of much help, however, unless
> the reflux is stopped, and that can't be done with medicine.
>
> HMc

I had a fundo surgery when i was, I think, 15. Was working great until
early last year when I saw the GI doc for the first time at age 26.
During the EGD, they found a hiatal hernia (which later went away),
signs of irritation in the esophagus, and the BE (low). I was doing
some heavy weightlifting (Squats) when I noticed this started
happening, hence the trip to the GI for the first time. Anyways, he
put me on PPI and while they worked good, it is not stopped
completely--but I wonder if it's due to stress and diet (although, I
can't tell you what foods trigger it--it varies). Im thinking of
calling the doc tomorrow and having him do an ambulatory PH test. Is
that a good idea? The thing is, they did that one test (I forget the
name) where you lie on the xray table and they spin you around and
watch the liguid. They didn't see anything abnormal there. But, if I
remember correctly, you said that it's not a very good test for acid
reflux?

Is it sounding like I'm gonna need another fundoplication depending on
the PH testing? My heartburn has been happening on and off now for
half a year now and I'm getting worried since I already have BE. To
me, it seems like the Doc is not too concerned. I also read the
material on the barrx website and it sounded too good to be true:
"BÂRRX Medical, Inc. today announced clinical trial results to be
presented at Digestive Disease Week in Washington, DC, May 19-24,
2007.In one of the studies, patients with the most advanced stages of
Barrett's esophagus, dysplasia and early cancer, were treated with the
HALO Ablation System, an endoscopic device which removes diseased
tissue without the need for surgery. After, 96% of patients were cured
of the disease, with average follow-up exceeding one year. Most
importantly, all genetic abnormalities associated with developing
cancer of the esophagus were eliminated after treatment."

96% is a whopping big number for success. Is that true or a marketing
gimmick for more funding?

Thanks for your posts, still appreciating everything you write in this
thread for 2 years now.
From: Howard McCollister on 31 Jan 2008 23:06
In article
<f57f1d60-c632-40ce-98fc-4579d794f3d3(a)i72g2000hsd.googlegroups.com>,
satxweb(a)gmail.com wrote:

>
> Is it sounding like I'm gonna need another fundoplication depending on
> the PH testing? My heartburn has been happening on and off now for
> half a year now and I'm getting worried since I already have BE. To
> me, it seems like the Doc is not too concerned. I also read the
> material on the barrx website and it sounded too good to be true:
> "B�RRX Medical, Inc. today announced clinical trial results to be
> presented at Digestive Disease Week in Washington, DC, May 19-24,
> 2007.In one of the studies, patients with the most advanced stages of
> Barrett's esophagus, dysplasia and early cancer, were treated with the
> HALO Ablation System, an endoscopic device which removes diseased
> tissue without the need for surgery. After, 96% of patients were cured
> of the disease, with average follow-up exceeding one year. Most
> importantly, all genetic abnormalities associated with developing
> cancer of the esophagus were eliminated after treatment."
>
> 96% is a whopping big number for success. Is that true or a marketing
> gimmick for more funding?
>
> Thanks for your posts, still appreciating everything you write in this
> thread for 2 years now.


Right, first an EGD with biopsies to confirm Barrett's and rule out
pre-cancerous dysplasia. Then, ambulatory pH testing (I recommend Bravo
at the time of EGD), then manometry.

We've been doing BarrX (HALO 360 and HALO 90) for quite awhile and I
must say the results have been impressive. On followup EGD,s we see
normal esophageal lining where there used to be Barrett's change, with
some little patches of residual Barrett's which we touch up with the
HALO 90 device. I agree, it looks impressive on paper, and I've been
impressed with our results, but it pays to be skeptical and cautious.
It's not something you need to rush into.

Yes, depending on the results of your EGD (upper GI/barium swallow is
totally worthless IMHO) and pH testing, you may need a revision. DO NOT
let them open you up. Find a surgeon who can do revisional laparoscopic
surgery. If they tell you they can't do it laparoscopically because of
your previous open surgery, find another surgeon.

HMc
From: skunker on 1 Feb 2008 11:58
On Jan 30, 10:06 pm, Howard McCollister <nos...(a)nospam.net> wrote:
> In article
> <f57f1d60-c632-40ce-98fc-4579d794f...(a)i72g2000hsd.googlegroups.com>,
>
>
>
> satx...(a)gmail.com wrote:
>
> > Is it sounding like I'm gonna need another fundoplication depending on
> > the PH testing? My heartburn has been happening on and off now for
> > half a year now and I'm getting worried since I already have BE. To
> > me, it seems like the Doc is not too concerned. I also read the
> > material on the barrx website and it sounded too good to be true:
> > "BÂRRX Medical, Inc. today announced clinical trial results to be
> > presented at Digestive Disease Week in Washington, DC, May 19-24,
> > 2007.In one of the studies, patients with the most advanced stages of
> > Barrett's esophagus, dysplasia and early cancer, were treated with the
> > HALO Ablation System, an endoscopic device which removes diseased
> > tissue without the need for surgery. After, 96% of patients were cured
> > of the disease, with average follow-up exceeding one year. Most
> > importantly, all genetic abnormalities associated with developing
> > cancer of the esophagus were eliminated after treatment."
>
> > 96% is a whopping big number for success. Is that true or a marketing
> > gimmick for more funding?
>
> > Thanks for your posts, still appreciating everything you write in this
> > thread for 2 years now.
>
> Right, first an EGD with biopsies to confirm Barrett's and rule out
> pre-cancerous dysplasia. Then, ambulatory pH testing (I recommend Bravo
> at the time of EGD), then manometry.
>
> We've been doing BarrX (HALO 360 and HALO 90) for quite awhile and I
> must say the results have been impressive. On followup EGD,s we see
> normal esophageal lining where there used to be Barrett's change, with
> some little patches of residual Barrett's which we touch up with the
> HALO 90 device. I agree, it looks impressive on paper, and I've been
> impressed with our results, but it pays to be skeptical and cautious.
> It's not something you need to rush into.
>
> Yes, depending on the results of your EGD (upper GI/barium swallow is
> totally worthless IMHO) and pH testing, you may need a revision. DO NOT
> let them open you up. Find a surgeon who can do revisional laparoscopic
> surgery. If they tell you they can't do it laparoscopically because of
> your previous open surgery, find another surgeon.
>
> HMc

Thanks Howard, it sounds encouraging. I was actually more worried
because I am gong to start flight training and may got into
cropdusting...and you know how the tight turns and stuff may cause
acid reflux, but I'm not sure, I'll need to find out from a flight
surgeon. Will report back later.
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