Hi Dr. Dengler. I was diagnosed with GERD after an endoscopy five years ago, which revealed erosive esophagitis grade 3. I then started PPI therapy and now I am on maintenance therapy of Pariet 20 mg daily. I have been taking this drug for five years now. A few months ago I had another endoscopy and a biopsy was taken from the mucosa of the lower esophagus and reveled non-classical Barrett’s changes (columnar non-neoplastic cells). I want to know your opinion about my case and if having fundoplication reflux surgery will be beneficial for me. I am scared of progressing to esophageal carcinoma since I am only 26 years old.
Thank you for your question!
About your condition
Erosive esophagitis is a pretty specific finding that confirms the diagnosis of GERD. This “erosive” form of reflux is particularly severe. However, at age 26, it is very unusual to have Barrett’s esophagus. Just because of your age and the implications of therapeutic decisions, I would recommend getting a second pathology opinion from an expert in GERD pathology. The term “non-classical Barrett’s changes” is unfamiliar to me, but could be referring to “visible columnar lined esophagus” without the cells needed to diagnose Barrett’s or possible microscopic columnar cells seen on biopsy. It is also important to know whether your esophagitis was healed on the second endoscopy. Regardless, you must be absolutely sure whether or not you have Barrett’s, hence the need to see an expert GERD pathologist.
Learn more: Visual symptoms of esophageal cancer
If you indeed have Barrett’s at such a young age, you have a long time to progress to more serious problems, particularly cancer. Risk factors for problems along these lines include being male, duration of symptoms, age at time of symptom onset, smoking, and obesity. Clearly you have several of these (male and age at time of onset).
Your treatment options – including reflux surgery
There are two issues that should be a concern to you at this time as you consider your options. The first is symptom control and what to expect for the future and the second concern is the esophageal cancer issue.
You will require PPIs for life with all of the inconveniences associated with taking daily medications. It is also not unusual to have to escalate your dose to control symptoms over the years. Additionally, the long-term side effects of these medications are of concern, particularly since you will be on them for life. On medications, stomach contents will continue to bathe your lower esophagus over the years which often creates further problems with esophageal function and again, raising cancer concerns. Medications do not stop reflux nor will they assure you that your disease will not progress; they simply remove acid as your reflux continues.
The surgical option has the potential to stop the reflux, produce long-term symptom relief and eliminating the need for medications. There are several options you might consider including the standard laparoscopic Nissen fundoplication reflux surgery and the newer LINX Reflux Management System. There are pros and cons of each, but you should become educated about them.
Learn more: GERD procedures at-a-glance
Find a GERD Specialist and consider a second opinion
Reflux surgery or not, at your age, you should see a GERD specialist about long-term management of your condition. Since you developed this at a very young age, from our perspective, this is disturbing. Reflux surgery is a very reasonable option, either this year or later down the road. This is one of those situations that is often controversial concerning the management of reflux. However, please remember that GERD is a significant disease and a long-term chronic condition that will be with you for life. We encourage you to take your disease seriously and create a partnership with an expert GERD physician who will look at all issues and treatment alternatives, both short-term and long-term.
Finally, I want to highlight that an important first step is to determine, at age 26, whether or not you have Barrett’s esophagus. Erosive disease is of concern, but your situation is even more complex if Barrett’s is present at your age.