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What Does My Endoscopy Report Indicate?

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Posted on Fri, 10 Nov 2017
Question: I had an endoscopy today. Dr. discovered he needed to dilate my esophagus, I was having some trouble swallowing, also found stomach polyps, and hiatal hernia. My lower esophagus is really tight making it very hard and painful to swallow. Think polyp was also discovered in esophagus. I am really in a lot of pain; difficulty swallowing saliva. No vomiting or fever. Just very painful. (Not in sore in throat area. Much lower). How concerned should I be? Also diagnosed from ultrasound with gallstones.
doctor
Answered by Dr. Ramesh Kumar (1 hour later)
Brief Answer:
Barrets esophagus proper medications should be taken..

Detailed Answer:

Hello,
Thanks choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.

Please go through every line and try to understand that basic cause of your problem is reflux of acid.Hiatel hernia is one of the common causes of GERD.Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation. the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.However in long term it increases risk of adenovarcinoma by 5%.Most of the times painful swallowing of food is associated with baretts esophagus.Need to dialte the food pipe is suggestive of baretts esophagus.
The esophagus is a muscular tube that is located in the chest and serves to transfer food from the mouth to the stomach. The lower esophageal sphincter (LES) is a valve that is located at the junction of the stomach with the esophagus. Its function is to prevent acid and other contents of the stomach from coming back into the esophagus. GERD is a condition in which excessive acid-containing fluid refluxes (flows) back into the esophagus, in part because the lower esophageal sphincter is weak.
In some patients with GERD, the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.

There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus.
If low grade dysplasia is present, endoscopic biopsy surveillance should be done every six months indefinitely.


Is a biopsy sample taken by your doctor?

Now managemebt consists of two step-
1)Control acid production-Take a proton pump inhibitor like Rabeprazole 20 mg twice daily.

2)Prevent reflux of acid formed back to esophagus

Please request your gastroenterologist to start you on PPI-antacids like Rabeprazole or Esomeprazole.Prisolec is a badic PPI and better options are there for treatment.
Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.

An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.

Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs should be given by your gastroenterologist to provide you with relief in your problem.
To prevent the esophageal damage from developing into late stage Barett ask your gastroenterologist to follow aggressive treatment pattern initially. As your symptoms will improve drugs can be tappered off gradually.
Avoid-
Dairy products, which contain sugar lactose that causes gas.
Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes.
Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples
Fiber.
Fatty foods and carbonated drinks.

Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps.
Take a high-quality probiotic.
Take external enzyme supplements.
Exercising, to help keep food moving through your system.
Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger.
Please attach reports of endoscopy to see grade of metaplasia.

Hope i answered your query in details and hope you understood my explaination.
In case you have more doubts feel free to ask.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar (13 hours later)
I haven't had any heartburn or GERD. Sorry I didn't say that more clearly in my question because my question was about my esophagus. I was wondering if being diagnosed before and after endoscopy with Gastritis would cause the same symptoms as GERD with the hiatal hernia? Is the treatment for that the same as GERD? Would the stomach pain that sent me for these tests be from the gallstones that were found during my ultrasound?
doctor
Answered by Dr. Ramesh Kumar (11 hours later)
Brief Answer:
All are related to each other and there is no test to differenciate them.

Detailed Answer:
Hello there,
See theoretically and pathologically(under a microscope) all these terms like Gastritis,GERD,esophagitis,Laryngeopharangeal reflux etc are different however clinically all are related to each other with common symptoms and treatment.

As told earlier Hiatal hernia is the commonest cause of GERD. If there is GERD there would be gastritis because if there is excessive acid to reflux back it would definitely irritate your gut also.As such there are no tests which can differenciate them. Infact all of them are related to each other.

In your first line you have mentioned that during endoscopy dr have to dilate your esophagus which means that there are some changes in mucosa due to excessive acid production and its reflux.

My lower esophagus is really tight making it very hard and painful to swallow-This symptom is not related to gallstone.However pain in stomach can e due to gallbladder stone also.
Please mention the size of gall stones.
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2913 Questions

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What Does My Endoscopy Report Indicate?

Brief Answer: Barrets esophagus proper medications should be taken.. Detailed Answer: Hello, Thanks choosing HealthcareMagic for your query. Have gone through your details and i appreciate your concerns. Please go through every line and try to understand that basic cause of your problem is reflux of acid.Hiatel hernia is one of the common causes of GERD.Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus is easily destroyed by acid which regurgitates back from stomach.This cause severe irritation of esophagus leading to inflammation. the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.However in long term it increases risk of adenovarcinoma by 5%.Most of the times painful swallowing of food is associated with baretts esophagus.Need to dialte the food pipe is suggestive of baretts esophagus. The esophagus is a muscular tube that is located in the chest and serves to transfer food from the mouth to the stomach. The lower esophageal sphincter (LES) is a valve that is located at the junction of the stomach with the esophagus. Its function is to prevent acid and other contents of the stomach from coming back into the esophagus. GERD is a condition in which excessive acid-containing fluid refluxes (flows) back into the esophagus, in part because the lower esophageal sphincter is weak. In some patients with GERD, the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium. There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus. If low grade dysplasia is present, endoscopic biopsy surveillance should be done every six months indefinitely. Is a biopsy sample taken by your doctor? Now managemebt consists of two step- 1)Control acid production-Take a proton pump inhibitor like Rabeprazole 20 mg twice daily. 2)Prevent reflux of acid formed back to esophagus Please request your gastroenterologist to start you on PPI-antacids like Rabeprazole or Esomeprazole.Prisolec is a badic PPI and better options are there for treatment. Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen. An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily. Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults. All these drugs should be given by your gastroenterologist to provide you with relief in your problem. To prevent the esophageal damage from developing into late stage Barett ask your gastroenterologist to follow aggressive treatment pattern initially. As your symptoms will improve drugs can be tappered off gradually. Avoid- Dairy products, which contain sugar lactose that causes gas. Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes. Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples Fiber. Fatty foods and carbonated drinks. Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps. Take a high-quality probiotic. Take external enzyme supplements. Exercising, to help keep food moving through your system. Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger. Please attach reports of endoscopy to see grade of metaplasia. Hope i answered your query in details and hope you understood my explaination. In case you have more doubts feel free to ask.