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What Does An Irregular Z-line Finding In An Endoscopy Report Indicate?
Question: How common is an irregular z-line finding on an endoscopy?
On my prior endoscopy (EGD) in August 2013, I had a finding of in an irregular z-line (with pink salmon island).
The biopsy can back benign tissue.
it did say in my esophagus:
1.) that i had columnar mucosa with signs of chronic inflammation
2.) squamous mucous with histologic features of GERD
3.) No intestinal metaplasia.
How bad is this report?
Recently - I have had stomach pains and bloating and am concerned of Barretts.
In mid 2014 - I had similar stomach issues and the GI doctor thought a repeat endoscopy uncessary and though my prescription of Deliant 60 mg might be too strong and switched me to Zantac 150 2 x per day. soon after the pain went away.
now - I am unsure if the pains are indicative of a bigger issue.
On my prior endoscopy (EGD) in August 2013, I had a finding of in an irregular z-line (with pink salmon island).
The biopsy can back benign tissue.
it did say in my esophagus:
1.) that i had columnar mucosa with signs of chronic inflammation
2.) squamous mucous with histologic features of GERD
3.) No intestinal metaplasia.
How bad is this report?
Recently - I have had stomach pains and bloating and am concerned of Barretts.
In mid 2014 - I had similar stomach issues and the GI doctor thought a repeat endoscopy uncessary and though my prescription of Deliant 60 mg might be too strong and switched me to Zantac 150 2 x per day. soon after the pain went away.
now - I am unsure if the pains are indicative of a bigger issue.
Brief Answer:
No Barretts esophagus signs in the biopsy.
Detailed Answer:
Hello!
Thank you for the query.
Irregular line Z is not very common finding in EGD, however it is not rare as well. Line Z is a border between stomach and esophagus. Irregular line is characteristic for inflammation of this area and can be a sign of Brretts esophagus.
Barretts esophagus is a permanent change in the esophageal mucosa. Intestine like cells appears instead of esophageal cells. This condition increases the risk of esophageal cancer.
Your biopsy report is good. You have no intestinal metaplasia. This is the most important information from this report.
The other finding are typical for chronic inflammation and are reversible. No sign of serious issues.
Stomach pains and bloating does not have to be caused by esophageal inflammation or GERD.
Typical GERD symptoms are chest burning, acid reflux, upper middle abdominal pain, nausea, lack of appetite.
Bloating is not characteristic for any stomach issues. But as you do take antiacids medicines, bloating is most likely caused by chronic bacterial inflammation of small intestine. Please note that when you decrease the amount of stomach acid, bacteria have easier way to get to intestines (stomach acid is a protective agent).
It is common that patients who take antiacids for long time have signs of bacterial chronic infection (sometimes called bacterial overgrowth).
Here is what I suggest you to do:
- discuss with your doctor Rifaximine treatment (special antibiotic for small intestine bacteria issue)
- if this wont help, gastroscopy should be repeated along with stool test and stool culture test
Hope this will help. Feel free to ask further questions.
Regards.
No Barretts esophagus signs in the biopsy.
Detailed Answer:
Hello!
Thank you for the query.
Irregular line Z is not very common finding in EGD, however it is not rare as well. Line Z is a border between stomach and esophagus. Irregular line is characteristic for inflammation of this area and can be a sign of Brretts esophagus.
Barretts esophagus is a permanent change in the esophageal mucosa. Intestine like cells appears instead of esophageal cells. This condition increases the risk of esophageal cancer.
Your biopsy report is good. You have no intestinal metaplasia. This is the most important information from this report.
The other finding are typical for chronic inflammation and are reversible. No sign of serious issues.
Stomach pains and bloating does not have to be caused by esophageal inflammation or GERD.
Typical GERD symptoms are chest burning, acid reflux, upper middle abdominal pain, nausea, lack of appetite.
Bloating is not characteristic for any stomach issues. But as you do take antiacids medicines, bloating is most likely caused by chronic bacterial inflammation of small intestine. Please note that when you decrease the amount of stomach acid, bacteria have easier way to get to intestines (stomach acid is a protective agent).
It is common that patients who take antiacids for long time have signs of bacterial chronic infection (sometimes called bacterial overgrowth).
Here is what I suggest you to do:
- discuss with your doctor Rifaximine treatment (special antibiotic for small intestine bacteria issue)
- if this wont help, gastroscopy should be repeated along with stool test and stool culture test
Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So - I have now had an EGD done in 2012 and 2013 that both said no intestinal metaplasia (from biopsies taken at irregular z-line).
What confuses me is that it did say I had columnar mucosa with signs of chronic inflammation. Is this something to be worried about as it is not squamous mucosa?
I would have to assume that my GI doctor who performed the EGD took the biopsies because of a suspicion of Barrett's due to the irregularities of the z-line.
I am nervous that this columnar mucosa noted on prior biopsy reports could be Barrett's today. How likely is that with respect to the 2012 and 2013 reports that confirmed no intestinal metaplasia?
What confuses me is that it did say I had columnar mucosa with signs of chronic inflammation. Is this something to be worried about as it is not squamous mucosa?
I would have to assume that my GI doctor who performed the EGD took the biopsies because of a suspicion of Barrett's due to the irregularities of the z-line.
I am nervous that this columnar mucosa noted on prior biopsy reports could be Barrett's today. How likely is that with respect to the 2012 and 2013 reports that confirmed no intestinal metaplasia?
Brief Answer:
Lack of metaplasia means you do not have Barrets esophagus.
Detailed Answer:
To diagnose Barrets esophagus intestinal metaplasia with goblet has to be present. This type of histological construction increases the risk of esophageal cancer (about 0,5% a year).
Lack of metaplasia makes your esophagus free from Barrets esophagus. Columnar mucosa can be present in Barrets esophagus, but without metaplasia, this does not make you prone to esophageal cancer. So I do not think you should be worried about that.
However this cellular changes could develop into a Barrets esophagus through this years. This is possible if your esophagus has been in constant contact with stomach acid. If you have been taking antiacids and your GERD has been well controlled, progression is less probable.
But it would be reasonable to repeat gastroscopy.
Lack of metaplasia means you do not have Barrets esophagus.
Detailed Answer:
To diagnose Barrets esophagus intestinal metaplasia with goblet has to be present. This type of histological construction increases the risk of esophageal cancer (about 0,5% a year).
Lack of metaplasia makes your esophagus free from Barrets esophagus. Columnar mucosa can be present in Barrets esophagus, but without metaplasia, this does not make you prone to esophageal cancer. So I do not think you should be worried about that.
However this cellular changes could develop into a Barrets esophagus through this years. This is possible if your esophagus has been in constant contact with stomach acid. If you have been taking antiacids and your GERD has been well controlled, progression is less probable.
But it would be reasonable to repeat gastroscopy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks you doctor for your answers. They have been tremendously helpful to me.
I am very health conscious (anxiety) over this type of stuff.
I was on Dexilant (Kapinex) 60mg since my initial EGD in October 2012.
Then in July 2014 - I was switched to Zantac (rantadine) 150 2 x per day - as it was felt that the Dexilant might be "too strong" and might have been the cause of some stomach pain I was having.
In January 2015 - I personally starting Nexium OTC - 40 mg because I felt I needed extra protection.
Then in April 2015 - the pain starting again - hence where I am now.
I am a vigorous exerciser (run 8 miles or bike 20 miles on 5 days of the week). I was always concerned that this may be causing acid to reflux because of stomach pressure increases. What are your thoughts on that?
And overall, do you think the medicines (even when I dropped down to Zantac 150) were enough protection to make advancement to Barrett's (metaplasia) less likely.
I know I have to make some other lifestyle changes as well (not eat later, eat smaller meals and slowly, reduce coffee)
Thanks again for your assistance.
I am very health conscious (anxiety) over this type of stuff.
I was on Dexilant (Kapinex) 60mg since my initial EGD in October 2012.
Then in July 2014 - I was switched to Zantac (rantadine) 150 2 x per day - as it was felt that the Dexilant might be "too strong" and might have been the cause of some stomach pain I was having.
In January 2015 - I personally starting Nexium OTC - 40 mg because I felt I needed extra protection.
Then in April 2015 - the pain starting again - hence where I am now.
I am a vigorous exerciser (run 8 miles or bike 20 miles on 5 days of the week). I was always concerned that this may be causing acid to reflux because of stomach pressure increases. What are your thoughts on that?
And overall, do you think the medicines (even when I dropped down to Zantac 150) were enough protection to make advancement to Barrett's (metaplasia) less likely.
I know I have to make some other lifestyle changes as well (not eat later, eat smaller meals and slowly, reduce coffee)
Thanks again for your assistance.
Brief Answer:
This medicines could be enough protection.
Detailed Answer:
Gym training, especially if its about abdominal muscles can increase pressure in abdominal cavity and cause some acid reflux. This is true. So it may worsen the symptoms. But it does not make Barretts esophagus more possible. So do not stop your exercises.
Medicines could be enough protection. But only if the acid reflux were controlled with this medicines. Please note that some patients do not respond to antiacids. This group of patients have acid reflux even when on this medicines. And this group of patients can be more prone to Barretts esophagus.
So if you havent had acid reflux symptoms during anticids treatment, this medicines were enough protection.
If there was still acid reflux present, Barretts esophagus could appear.
This medicines could be enough protection.
Detailed Answer:
Gym training, especially if its about abdominal muscles can increase pressure in abdominal cavity and cause some acid reflux. This is true. So it may worsen the symptoms. But it does not make Barretts esophagus more possible. So do not stop your exercises.
Medicines could be enough protection. But only if the acid reflux were controlled with this medicines. Please note that some patients do not respond to antiacids. This group of patients have acid reflux even when on this medicines. And this group of patients can be more prone to Barretts esophagus.
So if you havent had acid reflux symptoms during anticids treatment, this medicines were enough protection.
If there was still acid reflux present, Barretts esophagus could appear.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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