For new members with concerns about Barretts

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mudmagnetmum
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Date Joined Apr 2011
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   Posted 2/9/2012 4:00 PM (GMT -6)   
If you're new and reading this, welcome to Healingwell.

The issue of Barretts oesophagus crops up repeatedly and unfortunately Barretts still has bad "street cred" in terms of cancer risk. Here are a couple of links showing how the medical world is rethinking this now - the risk of transformation of Barretts to adenocarcinoma is now put at less than 1%. You should also remember that Barretts can be found in people without GERD, more so in men over 60 or so, but it is possible to have no signs or symptoms of GERD and still develop Barretts. It is also worth noting that there is no global (or even national in some countries) opinion on screening for Barretts or even when/how often to recall patients who have been found to have Barretts (without dysplasia i.e. early precancerous changes), there is also no consensus on who to screen as there is no defined "risk group" (though obviously if you've got GERD you'll get check over for Barretts anyway).

Have a look at -

http://www.nature.com/nrc/journal/v10/n2/abs/nrc2773.html
    (2010)

This recent study points out that 95% of cases of oesophageal adenocarcinoma have no prior diagnosis of Barretts....


http://www.nejm.org/doi/full/10.1056/NEJMoa1103042
       (2011)

This one is also very encouraging and questions the need for ongoing surveillance in people who have Barretts without dysplasia....

http://www.cghjournal.org/article/S1542-3565%2809%2901045-3/abstract (2009)
This one is a study (review) looking at the other studies/data around (a meta-analysis), which concludes "Patients with BE are at low risk of malignant progression and predominantly die due to causes other than EAC" (EAC = esophageal adenocarcinoma).

Here in the UK your risk of breast cancer (if you're a woman) is 1 in 8 (lifetime risk i.e. 1 in 8 women will get breast ca)
Here in the UK your risk of bowel cancer for women is 1 in 19, for men 1 in 15
Here in the UK your lifetime risk of developing oesophageal cancer for women is 1 in 118, 1 in 58 for men

So chances are something else will get you before Barretts does........ so I think we should all focus on whatever healthy eating and healthy lifestyle factors we can manage, and make symptom control and quality of life our priorities!!

MMM

Post Edited By Moderator (dencha) : 4/25/2013 5:32:12 PM (GMT-6)


mudmagnetmum
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Date Joined Apr 2011
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   Posted 2/9/2012 4:01 PM (GMT -6)   
NB: the cancer statistics are taken from http://info.cancerresearchuk.org/cancerstats/types/oesophagus/incidence/
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

sunbeam48
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Date Joined Jun 2011
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   Posted 2/10/2012 7:20 AM (GMT -6)   
Thanks, MMM! I so much appreciate the time you invest finding and posting information like this. When I expressed my reluctance to take a PPI to my GI doc, I felt he was using the cancer risk to compel me to take it. I'm still on Nexium, but continue to work toward finding the right combo to get my stomach settled and get off of it. I think the PPI risks are worse than the cancer risks for me, but an aching belly isn't exactly acceptable either.

stkitt
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Date Joined Apr 2007
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   Posted 2/10/2012 11:19 AM (GMT -6)   
MMM,
 
Another great piece of info and references.  Your right, this topic is often brought up and is a fear so many with GERD experience.  Thank you for sharing.
 
Kitt
~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

www.healingwell.com

"only as high as I reach can I grow, only as far as I seek can I go, only as deep as I look can I see, only as much as I dream can I be"

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 2/10/2012 1:04 PM (GMT -6)   
Thanks for the post MMM. I agree, and hate to be a potential downer, but wanted to share something.

I shared a study a while ago by some Swedish folks (I believe the name was Lundgregen (sp?). I can find it if anyone is very interested and can't find it. It essentially found that heartburn symptoms were strongly correlated with cancer risk, increasing with frequency, duration and time lived with symptoms (< 5 years, 5-15, 20+, etc.)...

So I asked my doctor about it, and he knew of the studies they had done. Since they were from 1999, he told me that it is generally believed that everyone had Barretts before the cancer, but it went unnoticed b/c Barrett's itself was only found in 1970...

So long story short, he told me confidently that Barretts is the mediator to cancer, and that if you don't get Barrett's, you can't get cancer. This is a top doc, his name is on stuff with the American Gastro Assoc. (his name is Nicholas Shaheen, @ UNC). He said a number of studies have shown that Barrett's always precedes esophageal adenocarcinoma.

So...I do think the fear of Barrett's is overplayed given the real risk it presents, but despite what my dr. said, I am a bit worried of studies that showed symptom history is more of a risk factor than esophageal mucosal status (barretts, esophagitis, or normal)...

So according to him, the "This recent study points out that 95% of cases of oesophageal adenocarcinoma have no prior diagnosis of Barretts...." would be interpreted as "they had it, but it wasn't found beforehand and then was destroyed by the cancer".

Just wanted to share that.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 2/10/2012 3:35 PM (GMT -6)   
Hi and thanks everyone. Kitt I was hoping for a thread we can keep bumping back up?

ARM, I personally wouldn't have any worries founded on a study from 1999 - if the same findings haven't been repeated and kept up to date then it isn't likely to still be relevant. The big Danish study followed people with Barretts, so even if they got cancer and that somehow eroded their Barretts, it would not have gone undetected.

What I was aiming for is some perspective - if people want to worry about Barretts then fine, but they must remember to worry about all the other cancers too, and risk of stroke and heart attack, because they are all far more likely to happen to someone than cancer of the oesophagus is!

MMM

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 2/10/2012 4:08 PM (GMT -6)   
http://info.cancerresearchuk.org/cancerstats/types/oesophagus/riskfactors/

ARM, If you read through the information on this website, which is kind of the cancer bible for the UK, I think you may be reassured. It discusses the Danish study too and adds a finding that obesity seems to be a separate risk factor.

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

mudmagnetmum
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Date Joined Apr 2011
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   Posted 2/10/2012 4:42 PM (GMT -6)   
http://repub.eur.nl/res/pub/16958/090520_Jonge,%20Pieter%20Jan%20Floris%20de.pdf#page=105

This link goes to a large PDF file which, if you have the time to trawl, gets down to specifics of the risk factors for development of adenocarcinoma in folk with Barretts. I haven't read the whole thing, but the summary says what's already listed above as risk factors: smoking, drinking alcohol, obesity, working in a stooped posture and being male (sorry guys) ...!

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 2/10/2012 4:47 PM (GMT -6)   
PS: In that big PDF chapter 5 Page 78, there's a fantastic pie chart showing deaths from all causes for people with Barretts . . . And the biggest cause of death . . . Drum roll . . . . HEART DISEASE !
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

mudmagnetmum
Veteran Member


Date Joined Apr 2011
Total Posts : 1604
   Posted 2/11/2012 8:47 AM (GMT -6)   
Sorry - the last link to the pdf file (a book) might not work, try:

http://repub.eur.nl/res/pub/16958/
then click on the pdf file (2nd one of the 3 listed)

It's a book called "Barretts Esophagus Revisited: Epidemiology, Risk Stratification and Cancer Prevention" by De Jonge.

I wish I had time to read the whole thing!

However, I really do recommend the pie chart on page 78, which shows nicely that if you have Barretts you are more likely to die from other things - shown as percentages, only 7% will die as a result of adenocarcinoma of the oesophagus, and causes of death for the remaining 93% are heart disease (34%) , lung disease (20%) and other malignancies (16%), to name the biggest causes.

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

Virgogirl67
Regular Member


Date Joined Feb 2010
Total Posts : 130
   Posted 2/12/2012 11:09 AM (GMT -6)   
Thanks MMM,
 
I have found this site after I had my Nissen Fundo and I am so happy I did, it is the most current, and it also has fellow Nissen patients that continue to stay involved.  I found all other sites outdated.  It's almost as if once they have the surgery and feel better, they just have nothing more to say. Or, maybe they find this site and join the support :-).  I continue to have a bit of issues about 9 weeks out, but all in all glad I had the Nissen.
 
I have Barrett's and that is one of the reasons my doctor agreed to the surgery.  He and the surgeon both make Barrett's sound like certain cancer in the future.  I had the Nissen because I could not stand that I burned through my Nexium most days and I took some form of PPI for 13 years and wanted to stop.  Unfortunately I cannot go off of them just yet.
 
My brother has Barrett's as well and his doctor scared him so much that he worried himself into anxiety attacks. 
 
On the other hand, my family doctor, who I think is just wonderful, said "you know, anyone with Barrett's almost always dies from some other ailment before the Barrett's ever turns to cancer - if at all."  So he made me feel better.
 
I just get tired of doctors contridicting one another, and they also tell us to stay off of sites like this because they are filled with false information, not founded in scientific proof.  Well, I disagree.  I think people who truly have a disorder/disease, or that had treatments for said disorders/diseases are the exact people to turn to. Most doctors do not have the health issues they treat people for, and it is as if they interpret studies different than one another.  So I say thank you MMM, and others on this site that continue to ease fears and be a part of a fellowship!!!

sunbeam48
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Date Joined Jun 2011
Total Posts : 795
   Posted 2/12/2012 2:32 PM (GMT -6)   
Boy, I agree with all you have said. Partly the docs don't have time to educate us, but some want the power of keeping us in the dark.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 2/12/2012 2:36 PM (GMT -6)   
Aww.. Thank you Virgogirl, nice to hear blush

Hope your recovery goes smoothly and that you reach a medication free zone before too long!

MMM

mudmagnetmum
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Date Joined Apr 2011
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   Posted 2/19/2012 3:22 AM (GMT -6)   
Bump
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

dreaming gator
New Member


Date Joined Feb 2012
Total Posts : 11
   Posted 2/19/2012 10:02 AM (GMT -6)   
Thank you for sharing this information. I am still a little concerned over the progression into cancer but it is not something that keeps me up at night. I just wish there was more research on barrett's and young adults/teens.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 2/19/2012 2:19 PM (GMT -6)   
http://www.nature.com/bjc/journal/v105/n2/abs/bjc2011214a.html

OK, here's a new one - came out in 2011. This study followed 133 patients around 25 years. At the final count, 96 died without high grade dysplasia or adenocarcinoma (they died of something else or plain old age) and 24 were still alive at the end of the study with no high grade dysplasia or adenocarcinoma (so I guess that means 11 out of the 133 had developed dysplasia). As my understanding of the article goes, I think it's saying those that had low grade dysplasia at the beginning of the study were likely to progress, but from the abstract doesn't make it clear how likely it is. The study also shows that diagnosis of Barretts at a young age (40s) means you are less likely to have progression, and the article ends by saying that developing high grade dysplasia or adenocarcinoma from Barretts has a long "incubation period" - "suggesting a true incubation period of three decades or more".

It's slightly less cheery than some of the other studies, but bear in mind most of the people either died of something else or had no dysplasia by the end of the follow up period. So perhaps maturer people who are diagnosed with Barretts (and no dysplasia) can be reasssured by the long period of incubation, and those of us who are younger, can be reassured by the fact that we're less likely to have progression.

Isn't it time they started changing what they say to people who are diagnosed with Barretts ........?

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

sunbeam48
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Date Joined Jun 2011
Total Posts : 795
   Posted 2/21/2012 9:43 AM (GMT -6)   


Cancer of the esophagus is increasing, perhaps related to the alarming increase in obesity. This article breaks down the two types of espohageal cancers, and descibes risk factors for each type.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 2/21/2012 12:25 PM (GMT -6)   
Yes, interesting. Basically has the same message as the other papers:-

"Approximately five to eight percent of people with GERD also have Barrett's oesophagus

However, as many as 95 percent of people with Barrett's esophagus don't know they have it.
about one-quarter of people with Barrett's have no reflux symptoms.

Although well-associated with adenocarcinoma, 90 percent of people with Barrett's esophagus will never develop esophageal cancer."

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 3/19/2012 3:22 PM (GMT -6)   
bump
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

theacidrefluxman
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Date Joined Oct 2009
Total Posts : 739
   Posted 3/20/2012 6:31 AM (GMT -6)   
Again, great thread MMM. I pop in now and then to remind myself of this.

Just curious...have you ever come across any info that shows symtom frequency and duration and their relationship to if you have Barrett's? I am curious to know if someone can struggle with symptoms almost daily for the majority of their life and still not develop Barrett's. Also just curious....seen anything in relation to an increased cancer risk for those who suffer GERD but don't have Barrett's?

I am just curious, and again love this thread. I am sure it is especially great to read for the newbies.

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 3/20/2012 2:42 PM (GMT -6)   
Thank you ARM, hope things are still good with you.

I haven't noticed in the studies, as I remember, any of the things you say. I think the 'hidden' risk group is older men who develop Barretts but have no symptoms of GERD and therefore don't seek medical intervention until such time as they start to have dysphagia (difficulty swallowing or pain swallowing), so they miss out on the early detection we GERD folk get. However, they haven't been able to prove in studies that having regular scopes improves your chances in terms of cancer detection or life expectancy.

I'm just looking at an article now which says about 40% of people with Barretts actually have no symptoms...........which is why they are looking for other methods of detection, something easy to use for mass screening, like a blood marker.

http://books.google.co.uk/books?hl=en&lr=&id=itAJFMYDmXkC&oi=fnd&pg=PA69&dq=duration+of+acid+reflux+%2B+Barretts&ots=wMN3M39SqT&sig=mXk3fCR7Bg-BNx8Xg7kMtfoA24o#v=onepage&q=duration%20of%20acid%20reflux%20%2B%20Barretts&f=false

(If the above link works, page 69 (Chapter 8) of this google book may interest you).

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

mudmagnetmum
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Date Joined Apr 2011
Total Posts : 1604
   Posted 4/2/2012 12:42 PM (GMT -6)   
bump
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

theacidrefluxman
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Date Joined Oct 2009
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   Posted 4/2/2012 1:46 PM (GMT -6)   
This deserves to be a sticky ;)

Ever come across why they haven't been able to prove in studies that having regular scopes improves your chances in terms of cancer detection or life expectancy? If early detection improves chances, either they are not recognizing it early, or early detection doesn't really improve chances...right? Its something I've wanted to ask my Dr. out of curiosity alone...

mudmagnetmum
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Date Joined Apr 2011
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   Posted 4/2/2012 2:05 PM (GMT -6)   
I think, from what I've read, that it IS difficult to detect early. I do remember coming across some very technical info about interpretation of the histology - which of course I'm not able to understand in any depth, but I would liken it to cervical cancer screening: cells that don't seem quite normal are detected and the woman is recalled but further testing doesn't yield better information, leaving the only sensible option of "wait and see" (regular monitoring). Nothing may come of it, but the woman mow has the worry that she may have cancer that can't be properly diagnosed and therefore not treated. I think it's perhaps similar for adenocarcinoma of the oesophagus - they have to keep repeating the biopsies in order to be sure of what they are looking at and whether or not it's changing? And it's not easy to access unless the patient(s) are very tolerant of the procedure.

If I can find the article again I'll post you a link.

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

theacidrefluxman
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Date Joined Oct 2009
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   Posted 4/2/2012 3:16 PM (GMT -6)   
I see. Reminds me of this...a new way to diagnose Esophageal cancer.

http://www.youtube.com/watch?v=dACnLri_aeQ
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