Prev: Ibuprofen and gerd?
Next: For Howard - Please help
From: christine.l.ayoub on 7 Apr 2008 15:26
Howard,

I have a question regarding inlet patches. On endoscopy, I have a
small inlet patch in the distal esophagus. I was told not to worry
about it and that it is of no consequence. Recently, I've read, on
the internet, that there has been some use of an ablation procedure
which has helped some people. I've also heard that some surgeons, in
Europe, will not operate on someone who has an inlet patch. I am doing
pretty well on 30mg of Prevacid, but I still have globus sensations
and hoarsness when talking. My initial symptoms were difficulty
swallowing; I did not have typical heartburn. Also, my endoscopy
showed "mild Grade 1 reflux esdophagitis with superficial erosions and
erythema of the distal esophagus just above the gastroesophageal
junction". If it is alright to have a fundo with this inlet patch,
should I have an ablation done first?

I would just like to separate fact from fiction on this issue. Do
some inlet patches secrete acid and are the contraindicated for a
fundoplication? Also, does albation increase the risk of scar tissue
and stricture?

Thanks!

Christine
From: H McCollister on 7 Apr 2008 18:43
In article
<de459960-f70f-477f-8f78-3f6cb3fa801a(a)n14g2000pri.googlegroups.com>,
christine.l.ayoub(a)intel.com wrote:

> Howard,
>
> I have a question regarding inlet patches. On endoscopy, I have a
> small inlet patch in the distal esophagus. I was told not to worry
> about it and that it is of no consequence. Recently, I've read, on
> the internet, that there has been some use of an ablation procedure
> which has helped some people. I've also heard that some surgeons, in
> Europe, will not operate on someone who has an inlet patch. I am doing
> pretty well on 30mg of Prevacid, but I still have globus sensations
> and hoarsness when talking. My initial symptoms were difficulty
> swallowing; I did not have typical heartburn. Also, my endoscopy
> showed "mild Grade 1 reflux esdophagitis with superficial erosions and
> erythema of the distal esophagus just above the gastroesophageal
> junction". If it is alright to have a fundo with this inlet patch,
> should I have an ablation done first?
>
> I would just like to separate fact from fiction on this issue. Do
> some inlet patches secrete acid and are the contraindicated for a
> fundoplication? Also, does albation increase the risk of scar tissue
> and stricture?
>
> Thanks!
>
> Christine

That's a rather controversial issue - the main controversy being whether
it's a congenital gastric mucosal rest or an acquired metaplastic island
similar to Barrett's. These patches do tend to secrete gastric acid, but
I'm not aware that it represents a contraindication to fundoplication. I
agree that this is generally considered to be inconsequential, assuming
that they biopsied it for H pylori as well as intestinal metaplasia
(which would indicate that it's an island of Barrett's esophagus).

It could be ablated or endoscopically resected, although the evidence as
to whether or not that's necessary is minimal if the patient is
asymptomatic. In your case, it's not clear whether or not you are, since
globus sensation or other dysphagia is one of the symptoms of a
troublesome inlet patch. The problem is, those are also symptoms of GERD.

In the absence of intestinal metaplasia and/or H. pylori in the inlet
patch on biopsy, and in the absence of visible scarring, stricture,
erosion, and in the presence of erosive esophagitis at the GE junction,
I would be inclined to do nothing with it, and proceed with
fundoplication if otherwise indicated (my opinion).

I don't think I'd consider the subject "fact vs fiction"...I think it's
more a matter of differences of opinion about a subject that has not
shown clear evidence of being dangerous. Some doctors think it's
minimal, other think it might be *potentially* problematic. I'm not sure
about ablation since inlet patches are generally considered to be
inconsequential. I've never done that for an inlet patch. Although I
suspect it would be relatively simple to do endoscopically using a Halo
90 radiofrequency device (BarrX), I'm not sure it's necessary,
particularly since it's not clear that it is in any way related to your
symptoms, and since you don't have clear evidence that the inlet patch
is pathologic.

HMc
From: christine.l.ayoub on 7 Apr 2008 23:37
Howard,

Thanks for the information. The patch was not biopsied, so maybe it
was considered to be too small and I shouldn't worry. In any case, I
have a lot to think about and I may go back and ask my GI doc more
questions. Maybe on my next endoscopy, I will ask them to biopsy it
for me. I really appreciate your detailed response.

Christine
 | 
Pages: 1
Prev: Ibuprofen and gerd?
Next: For Howard - Please help