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HomeAnswersSurgical Oncologygastroesophageal reflux diseaseI am experiencing mild GERD. Please help.

Can untreated GERD cause Barrett's esophagus?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Arvind Guru

Medically reviewed by

iCliniq medical review team

Published At March 29, 2024
Reviewed AtMarch 29, 2024

Patient's Query

Hello doctor,

I have a mild GERD for which I take a PPI as needed. I never experience anything severe like waking up in the middle of the night, etc. Additionally, I had a pH test a couple of months ago which was not too concerning, and an endoscopy done three years ago which showed no issues. My main concern is that I suffer from health-related anxiety and constantly worry about developing Barrett's esophagus. Given the information I have provided, would it be likely for me to have developed it? Also, every now and then (though not often), I wake up with a foul taste in my mouth, kind of sour, bitter, just generally unpleasant. I know this could be caused by various factors, but do you think it could be related to GERD?

Please advise.

Thank you.

Answered by Dr. Arvind Guru

Hello,

Welcome to icliniq.com.

I understand your concern.

For a more detailed assessment, I would appreciate learning more about your specific concerns first. It would be beneficial if you could kindly provide your PH (potential of hydrogen) test and endoscopy reports, along with any other relevant test results and previous hospital records. Regarding your anxiety about Barrett's esophagus, I can provide the following information:

Among individuals worldwide with GERD, only 10 to 15 percent will develop Barrett's esophagus, and out of those, only 1 percent will develop cancer each year. So, if someone has untreated GERD (which yours is treated), the risk of cancer developing is approximately 0.1 percent per year, equating to a 1 percent risk over 10 years if left untreated. Moreover, while Barrett's esophagus is irreversible, it can be managed effectively. Considering these statistics, it is evident that the risk of cancer is very low. Now, compare this risk to that of other diseases such as colon cancer (affecting 6 percent of the general population) or even more prevalent conditions like prostate cancer. Additionally, the likelihood of experiencing a heart attack or stroke is even higher. My point is, that just because a possibility exists, it does not mean it will necessarily happen to you. Therefore, I encourage you to try to relax and not dwell excessively on these concerns.

Here are some steps you can take to reduce the risk of Barrett's esophagus and, consequently, the risk of cancer:

  1. If you are currently taking a PPI (proton pump inhibitors ) only once a day, consider adding the tablet Ranitidine 150 mg to be taken an hour before bedtime and at least an hour after meals at night. This may help control nighttime reflux, which PPIs alone sometimes struggle to manage effectively.
  2. Work on reducing your weight, as it is a significant risk factor for over 20 different cancers. Aim to achieve a BMI (body mass index) of less than 25, which is the best preventive step you can take against various diseases. When trying to lose weight, aim for a gradual reduction of around one to two pounds per week, as this is more sustainable in the long term. Plan for a period of around one and a half years for weight loss. Your target weight should be less than 127 pounds, meaning you currently have an excess weight of around 35 pounds. It may take around eight to nine months, accounting for fluctuations. Walking, jogging, and aerobics are excellent exercises for weight loss. Aim to exercise for at least 30 minutes per day, a minimum of three to four days per week.
  3. Regarding diet control, it is crucial to start counting calories to effectively manage your intake. The United States Department of Agriculture (USDA) has an excellent website for this purpose. Decrease overall carbohydrate intake and replace refined grains with whole grains. Millets have a better metabolic profile than wheat, so consider adding them to make up around 10 to 20 percent of your dietary cereals. Your total recommended daily calorie intake is approximately 1600 kilocalories, with protein comprising around 2.1 to 2.4 ounces
  4. When going to bed or sleeping, try lying on your left side, as this can help reduce reflux.
  5. If you are seeking a permanent solution, consider surgery to fix your GERD, especially if your symptoms are worsening or if tests like the PH test or endoscopy reveal suggestive features such as bile reflux, erosion, or associated hiatal hernia. Surgery can address the underlying defect causing GERD in the first place.

The pros and cons of surgery for GERD are as follows:

  1. Surgery is preferable to taking pills for a lifetime.
  2. Surgery can effectively address the underlying defect causing GERD, thereby managing both acid and bile reflux. Bile reflux, often neglected by PPIs, is considered an important factor in the development of Barrett's esophagus.
  3. However, there is no definitive evidence that surgery reduces the risk of Barrett's esophagus progression to cancer once it has already occurred.
  4. On the downside, although modern surgical techniques are very safe, there are still potential problems and complications associated with surgery.

Discuss the above information with your doctor. Only proceed with the medicines/measures suggested after receiving approval from your treating doctor. This online consultation is meant to complement or supplement the advice of your treating doctor and is not intended to entirely replace a thorough, in-person evaluation by a qualified medical practitioner.

Hope this helps you and get back if you have any doubts.

Thank you.

Patient's Query

Thank you so much doctor for your detailed response,

I was able to have an endoscopy this morning. Could you look at the report and give me your opinion? Are the findings quite common, and is there anything to worry about? I need to lose some weight and take some different medication. If there were no visible signs of Barrett's, is it unlikely that a biopsy will show Barrett's?

Please advise.

Answered by Dr. Arvind Guru

Hello,

Welcome to icliniq.com.

I am glad that I could be of some use to you.

I have reviewed your report (attachments removed to protect the patient's identity). As I suspected, you have mild reflux esophagitis, along with some gastritis. Regarding Barrett's esophagus, the diagnosis requires two things to be present together: endoscopic features and biopsy. Biopsy is typically performed during an endoscopy, even if suspicion is very low, for convenience. Therefore, do not worry; most likely, it will be okay.

The grade A esophagitis (the very first stage) that you have is very common in the population with GERD. I agree with your doctor's prescription. As I recommended in our previous communication, you have been prescribed nighttime Ranitidine in addition to PPI. Sucralfate, another medication that has been added, helps heal the gastritis over four to eight weeks. I noticed Venlafaxine on your prescription. I have two points to address regarding it, which are as follows:

  1. This drug could itself be responsible for your gastritis.
  2. It could also be responsible for your anxiety regarding the possibility of Barrett's. Discuss this with your doctor; however, do not stop or reduce it on your own.

Perhaps you should try some relaxation exercises like yoga or meditation. Visit a good local instructor nearby or explore reputable online sources. There are many videos available on the internet as well. These exercises can help balance the neurotransmitters in your mind and promote peace. Many people are uncertain about them initially, but I suggest trying them; they may be beneficial for you. I hope your doctor also advised you about smoking and alcohol consumption.

Follow up if you need any kind of help.

Wish you a healthy and happy life!

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Arvind Guru
Dr. Arvind Guru

General Surgery

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