This question highlights why it is so important to not ignore your acid reflux symptoms or mask them with powerful antireflux medications. GERD is a progressive chronic condition that, if not managed properly, can reduce the quality of your life or even take it from you.
I have progressed to low grade dysplasia, diagnosed less than 6 months ago, after 10 years of monitoring while on PPIs. An ablation was recommended, but it’s my understanding that this procedure removes the Barrett’s, but it does not address my GERD condition. Is it suggested (recommended?) to have a TIF procedure done at the same time? I am hoping that an ablation addresses the GERD as well as future symptoms. Please advise. Thanks.
- Symptoms: heartburn, chronic cough, frequent throat clearing
- Endoscopy diagnosis: YES
- GERD stage: Stage 4 (Barrett’s esophagus)
- BMI: overweight (27 – 30)
It starts with a sudden onset of heartburn after a big meal, or perhaps a cough that just doesn’t seem to go away. More symptoms develop, constant throat clearing or a burning in the esophagus. At first, most of us consider this an inconvenience, something like a cold virus which, if we just wait it out, the problem will resolve itself at some point. But acid reflux disease doesn’t work that way.
Acid reflux symptoms: the canary-in-the-coal-mine
In the US, it is estimated that 1 in every 3 adults have acid reflux symptoms once or twice a month. This is the early warning sign, the “canary-in-the-coal-mine”. During the early days of coal mining, miners took canaries into the mine as an early warning system. Since canaries are more sensitive to small concentrations of carbon monoxide or methane, back then they were an ideal alarm. When the canary died, miners knew it was time to get out of the mine.
The human body has its own canary-in-the-coal-mine warning system for many diseases and conditions. Although some adults with GERD experience no symptoms, many experience heartburn, chest pain, regurgitation, a chronic cough, hoarseness, or persistent throat clearing, to name a few of the most common symptoms. However, unlike the miners when the canary died, few consider their GERD symptoms to be serious enough to take action.
Disease progression: GERD/LPR to high grade dysplasia
The progression of early GERD symptoms to serious complications such as high grade dysplasia is slow; there is typically plenty of time to recognize the disease, diagnose it, and treat it. Drs. Kahrilas and Howden discussed this in their article asking, Is GERD a progressive disease?
“The reported rates of progression are relatively low over a 20-year period, the longest timeframe for which published data exists. Furthermore, the risk of developing a stricture, Barrett’s metaplasia, or esophageal adenocarcinoma appears to be very low within the 2 to 20-year timeframe of these studies. However, slow disease progression likely occurs over decades because high-grade esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma are all more prevalent among the elderly.”
More importantly, the incidence of Barrett’s esophagus and esophageal cancer are increasing worldwide at an alarming rate. This progression is well understood, and as GERD progresses, the risk of advancing to esophageal cancer increases as well:
- Non-erosive acid reflux
- Erosive esophagitis
- Barrett’s esophagus
- Low grade dysphasia
- High grade dysphasia
Barrett’s esophagus as well as low and high grade dysphasia are considered pre-cancerous, and each has an increasing risk of esophageal cancer.
Options to stop disease progression
You asked about ablation of the damaged cells in your esophagus. The results of ablation by itself are very exciting. In a study tracking 136 patients with low grade dysplasia, half received radiofrequency ablation and half were only monitored via endoscopy (control group). After a 36-month follow up, the study found: 1) 1.5% of the ablation group progressed to high stage dysplasia or adenocarcinoma compared to 26.5% of the control group, and; 2) esophageal cancer developed in 1.5% of the ablation group compared to 8.8% of the control group. Over 92% of those in the ablation group had complete eradication of dysplasia. Clearly, RF ablation by itself appears to have a substantial benefit.
Antireflux surgery is another option for you to consider after RF ablation. Although RF ablation has demonstrated remarkable results over three years, without physically fixing the lower esophageal sphincter, reflux will continue. Over a longer time frame, it is possible that damage to the esophagus will occur – resulting in a reoccurrence of a pre-cancerous condition. One of RefluxMD’s members was advised to have a TIF procedure after RF ablation in an article titled Endoscopy procedure uncovers Barrett’s esophagus after years of PPIs. I highly encourage you to read his story.
The “hopefully waiting” option
Many with low and high grade dysplasia are hopefully waiting while continuing with PPI medications. Should you choose this treatment plan, we suggest you focus on weight management, adopt a GERD-friendly diet, make the necessary lifestyle changes, and utilize the least powerful medications to treat your symptoms. In GERD stage 4, this approach may not be enough to stop the potential for further disease progression. However, we highly recommend that you always focus on these healthy actions since they may still help with your symptoms and certainly and they are important to your overall health.
Your BMI is an issue, and we recommend that you develop a program to reach and maintain a BMI of 24 or less. Your BMI indicates that you are extremely overweight (not yet obese), which increases the pressure on your diaphragm and may result in reflux along with GERD symptoms or even . You might consider Scale Down for Relief, a proven rapid weight loss program that includes 1-on-1 health coaching along with personalized GERD counseling.
We always encourage a second opinion by a GERD expert since they will provide you with every treatment option. Should you decide to reduce your use of PPIs, we recommend this be done under the care of a physician and that you follow a step-down program such as the process developed by our medical advisors. There are serious consequences to reducing or stopping PPIs too quickly.
I hope this helps and we wish you the very best on your path to relief and good health!