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How common is it to diagnose Barrett's esophagus in a 13 yo male based on cardia-type mucosa positive for acute and chronic inflammation, ulceration and focal intestinal metaplasia? What is the difference in efficacy of an H2 blocker vs a PPI?

Wow, has to be very uncommon. Some older references I've read state less than 15% below age 50. PPIs are said to be the best, but recent concerns about long term safety of PPIs have made me alternate H2s and PPIs in my adult Barrett's patients. What about other factors: ZE syndrome, smoking, alcohol, high consumption of cured meat (nitrosamines)?

This patient transferred to me two months ago. The complaint was vomiting since birth. Of course, I thought what everyone thinks when they hear that. But, I did a workup for chronic vomiting and put on an H2 blocker. I am not sure if he had either prior.

I referred him to GI on day one.

Not really my thing since I only do adult GI, but Barrett's is primarily a disease of middle-aged adults and is unusual in children. In the past, diagnosis was based on endoscopic appearance but now requires the pathologic result you describe (metaplasia). It sounds like your 13 year old was appropriately diagnosed.
The risk of adenocarcinoma is significant, even in children, and though the studies are a bit unclear, to me the minimal risks associated with ppi use are outweighed by the potential for cancer prevention. Of course that assessment may be a bit different for a child. Of course if symptoms are not controlled by an H2 blocker and anti-reflux maneuvers, that would be even more reason to use a ppi.
Happy 4th everyone!

Jon, if kid still has metaplasia after using PPI, do you think ablation (RFA) since so young and will be dealing for Barrett's for many decades?

Yeah, from what I read, given the number of people who go on to develop adenocarcinoma and the fact that he is so young (given more person years), one would need to rather aggressive. I think I read ablatin was for dysplasia and not metaplasia, but at the same time, he is still vomiting all the time, so a fundoplication may be necessary.

I wish we had more interesting medical discussions on here, instead of just the usual chart and tech stuff. It's always interesting.

Interesting article in Family Practice News about a study at Mayo CLinic using a sponge on a string to diagnose Barrett's.
Swallow EsophaCap and wait 10 minutes and then pull the expanded (25mm) sponge back through the esophagus and then do PCR testing on 2 DNA markers.
Initial study was 100% specific and 100% sensitive and no endoscopy needed.

Greg

I agree Chris. Hell, I could put my top five diagnoses of the week on here. Having me as a pediatrician is now considered an independent risk factor.

I think many don't know about this. If we start more, we will get more. Just need to obviously keep out identifying information. If something slips in, then we should notify the mods to edit it out.

I continue to be increasingly frustrated with the vaccine situation with pediatrics in Alaska. You know the West coast.... It's not the MMR anymore but the HPV vaccines is supposed to cause something or other, and it's "too new to trust." About half the mom's are refusing HPV vaccine for their kids. We came up with a cure for cancer, and they reject it. It just shows if we ever come up with immunotherapy to cure breast cancer, prostate cancer, etc, people will still refuse treatment.

The anti-vaccine movement is just nature's way of culling the herd. Kind of like voluntary natural selection.

Yeah, but Robert DeNiro just said vaccines were bad, so I think the CDC and AAP got it wrong.

I love when we have our annual Pertussis epidemic. Then they line up at the door for the shot.

Hi Guys,
I was visiting AC board and saw this thread thought I'd drop in and say hello and ask a curbside consult of my favorite group of docs.

I was Dx'ed with Erosive Esophagitis about 5-7 years ago and have been taking 40 mgs of Nexium pretty much consistently ever since although I did do Step Therapy upwards for just a bit. I also was diagnosed with Rip Roaring entire Colon Ulcerative Colitis at that time as well. I also was able to get Dexilent covered for awhile but eventually had to cut back to Nexium. My dose varied awhile because NYS carriers stopped covering actual Nexium and moved me over eventually to OTC version (Same thing but slightly different dose) so I took 2 capsules at what if I remember was 22 or 23 point something or other named brand OTC times two for a slightly higher dose. Now I'm back at regular 40's once daily. I do wonder if, because Dexilent seems to last longer, more effective as I have been told by my own GI if all this up and down has impacted my body in anyway not that I don't have one bad human habit of my own to contribute to my troubles... I love Pepsi and drink it regularly and I drink regular coffee light with 1 or 2% Lactaid.

On very recent reexam of both top and bottom scopings my UC has calmed down and receded to a much smaller section of my colon and some non cancerous polyps were removed as well. BUT, now my EE has evolved into Barrett's and obviously I'm pretty darn concerned. And the mention of ZE here just gave me the shivers as I have never heard of such a thing before...

But my Paternal Grandfather died fairly young of some sort of Pancreatic Cancer (68 years old). I've had full body cavity scans once or twice before just in case because of this family history combined with a hard to describe or pin point a cause of a fairly consistent pain on my left side just at the rib tummy line that get's especially bad on long drives when I'm obviously squashing my guts together sitting straight up for long periods of time. Those scans were clean and nobody said anything of interest about them. But internal pain that I can not say if it is just a long term strain or my UC colon being a pain or something else lead us to do it all, again just in case.

1) So, are there any other causes of Barrett's besides acid and reflux?

2) I read that Barrett's converting to a cancerous state was still pretty low but higher than normal population numbers. What is the truth about all this?

3) I've always wondered about things like HPV which most of us sexually active middle aged folks probably have been exposed to as a possible cause. Seeing that we are finding more and more cancers and the like being associated with various infections lately including Throat with HPV, why the heck not, right?

4) Is there anyway to possibly reverse this nasty thing before it progresses to the next more concerning stages? And should I consider getting the GI to get the Dexilent approved seeing that it is supposed to really last the full 24 hours or close to it at least as compared to other PPI's presently on the market.

5) I do take my Nexium as two 20 mg caps and I do spread them out by a few hours, usually one in the morning and then one later around 4 pm with my other 2nd dose meds to try and spread out the coverage since I was taught that Nexium really last about 20 hours or so tops. My GI used to give local talks on and for Nexium at some dinners I used to attend.

I have been trying to cut back on my nasty love of Pepsi lately and going back to good old coffee which never seem to impact me the way the soda does. But caffeine is my one and only real vice I have left. I was a fairly heavy smoker between my late teens and about 26 years old when I quite pretty much for good. Those of you who know me I used to be in a very crazy abusive relationship and so I returned to smoking twice when things got heavier and crazier for about two, 6 month stents in 96-97 and again in 2008-09 but I've been tobacco free ever since and otherwise. The past two years have been a crank up in a new and crazy level of abuses from afar of a more controlling financial like manner cause tons of worry and stress around our home and family... I sure I must be suffering some of those stresses internally in my body, brain and gastrointestinal systems.

Any insights or thoughts, tests to be considered or suggestions would be greatly appreciated from this knowledgeable group of friends. I need to stick around a good long time for my two still recovering from it all teenaged kids no less myself...

Sorry to impose and thanks so much my dear old friends,
Paul

Wow! I was about to delete this whole forum.

Paul, I would PM Jon (JBS) and ask him to take a look. There are probably other GI specialists on the board, but I KNOW he is one, and he follows the board.

(I'm still following the other stuff)

I cant believe I was still "watching" this post.

I don't know why I didn't see it earlier but the Barrett's caught my eye and I figured what the heck... That ZE sure sent a shudder of a chill up my spine... PC has always worried me in the back of my mine as that cancer you usually never discover until you're a dead man walking.

I guess please keep it up here for awhile longer and thanks for the lead... and I eagerly await your answer on the DB when you get a free couple of moments... Assume NOTHING. My mind is really is MUSH and that worries me too... PPI's, PTSD, far too many bad hits to the head from years of sports and other insults to my skull....

I sure do miss this place. Have a great night and be good,
Paul

Hell, you are always welcome here. And, we are all dead men and dead women walking from day of life. (That was deep)

Yikes! We are hijacking our own thread. No, I will keep it up now that it may get some more attention.

Several good questions, Paul.
I answered in a PM.

You're the Best Jon... Thanks so much for your wonderful detailed response!

Paul