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Barrett’s Esophagus: Need Advice For Treatment, Tips
Professor Snugglesworth
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My father has been diagnosed fairly recently with Barrett's Esophagus. In addition, he's been undergoing multiple tooth transplants, which so far involve the removal and replacement of all his front teeth. Basically a double whammy of shitty issues.
He's been seeing the necessary doctors for the former and dentists for the latter, but he's also been having this recurring problem that we so far are unable to determine if it's a result of one or both symptoms, or a combination of the two. Every few days or so of the week, he's unable to properly swallow certain kinds of foods. He used to be the type who would eat burgers, steaks, and all sorts of meats. These days, he's lucky if he can keep down spaghetti and rice.
The way he describes it is that there's a "blockage" that keeps the food from entering his throat, causing him to gag it back out. This seems to happen purely randomly, and as far as I can tell, he has the easiest time with fried seafood and chicken. Panko Shrimp and Fish is something he's able to eat most of the time, as is fried chicken and certain lasagna.
But there are days where he can't even eat these "safe" foods. About the only thing he's been able to consume with no problem is liquids, namely red wine.
When describing this issue to his dentist, the dentist is unable to come up with a cause for this. If it turns out that the Bearrett's Esophagus is the leading cause, all I know is that he's been taking omeprazole once a day.
I've decided to try and do my own research, as I've grown concerned with his eating woes. I would like to stress that my father is a bit of a "relic", as in that he never wants to talk about his issue and doesn't try to research possible treatments or tips, instead choosing to "tough it out". Frankly I despise his way of thinking, especially in this current era where people can look up answers to just about every ailment.
But I won't claim for certain that he's doing everything he's supposed to...that's why I'm coming to you for advice. If you know of any kinds of treatments, examinations, foods, or anything at all that may help, I would love to read about it.
If you have any other questions, just ask, even though I know full well it's going to be a process to get an answer out of him.
He's been seeing the necessary doctors for the former and dentists for the latter, but he's also been having this recurring problem that we so far are unable to determine if it's a result of one or both symptoms, or a combination of the two. Every few days or so of the week, he's unable to properly swallow certain kinds of foods. He used to be the type who would eat burgers, steaks, and all sorts of meats. These days, he's lucky if he can keep down spaghetti and rice.
The way he describes it is that there's a "blockage" that keeps the food from entering his throat, causing him to gag it back out. This seems to happen purely randomly, and as far as I can tell, he has the easiest time with fried seafood and chicken. Panko Shrimp and Fish is something he's able to eat most of the time, as is fried chicken and certain lasagna.
But there are days where he can't even eat these "safe" foods. About the only thing he's been able to consume with no problem is liquids, namely red wine.
When describing this issue to his dentist, the dentist is unable to come up with a cause for this. If it turns out that the Bearrett's Esophagus is the leading cause, all I know is that he's been taking omeprazole once a day.
I've decided to try and do my own research, as I've grown concerned with his eating woes. I would like to stress that my father is a bit of a "relic", as in that he never wants to talk about his issue and doesn't try to research possible treatments or tips, instead choosing to "tough it out". Frankly I despise his way of thinking, especially in this current era where people can look up answers to just about every ailment.
But I won't claim for certain that he's doing everything he's supposed to...that's why I'm coming to you for advice. If you know of any kinds of treatments, examinations, foods, or anything at all that may help, I would love to read about it.
If you have any other questions, just ask, even though I know full well it's going to be a process to get an answer out of him.
Professor Snugglesworth on
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Then again, he has mentioned days where he's felt more "stressed" then others, so maybe I should look into that further. It's unlikely though.
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Dysphagia is a good reason to see a doctor, and he should do so. At the very least, he can get some imaging studies done like a barium swallow study.
Barrett's can be a precursor to esophageal cancer - if there is a growth stopping food from going down, he probably needs to get a scope and a biopsy ASAP.
He should make sure not to slack off on treatment on the Barrett's, that's decently advanced trouble in the esophagus. That's one area where you want to diagnose cancer as early as possible if you have it, but most people who get it don't find out until it has advanced which leads to a very high mortality rate for esophageal cancer.
Two things can happen at this point, or just one thing happens and we found out that one was wrong, I forget. Esophagus cells still remember how to be stomach cells, so they turn into stomach cells to better handle the acid. Either that or stomach cells can be washed into the esophagus by the acid and grow there. Either way, you've got columnar cells where squamous cells should be, and that's bad for a couple reasons. One, these cells are not normal esophagus cells, so you'll have problems with lower esophagus function. Two, having a cell change into another cell because of an insult is never good, therefore the cancer risk.
That could be one of the causes of the dysphagia - hyperplasia or cancer in the lower esophagus, causing a block. That's why this sudden dysphagia is an alarm sign that should cause you to schedule a doctor visit immediately, and don't be surprised if the doc goes as far as an esophageal biopsy.
Other things that could be doing it are achalasia (rare denervation of the lower esophagus, which causes constriction because the nerve signals are supposed to hold it open when there's food above it) corrected by surgery. Another differential is diffuse esophageal spasm, which is also associated with acid reflux. This is where your esophageal nerves and muscles just don't know what they're doing, so you get spasms there from all sorts of signals, like whether your food is hot or cold, whether you're stressed out, if you smell a specific thing, really random trigger stimulation. This commonly comes with heartburn and/or chest pain, so watch for that. It and a lot of other lower esophageal sphincter diseases are best detected by a barium swallow, which is that X-ray that shows what some liquid you just gulped down is doing in your gut. Your doc will probably most definitely give you that.
Yet another part of the differential is cardiovascular related. The heart is right next to the stomach/esophagus, so an enlarged heart could be pressing on it. There's also a congenital abnormality (unlikely because of age) where the aorta can go around the esophagus and make a vice clamp around it when lots of blood is flowing through it, which could show up if you develop hypertension. Also, if you have heart failure causing backup of blood in your veins, you could get portal hypertension which is basically blood backing up right before your liver that gets pushed all sorts of places, one place being the esophageal varices around your esophagus. It's like hemorrhoids but with your esophagus and not your rectum.
Yet another part of the differential, and this is common, are esophageal rings that form as a result of some sort of inflammation or whatever - if I can be crude, think of the structure like a hymen at your esophagus, a mucosal ring that formed as a sort of malformed scar that makes your esophagus diameter way smaller than it should be. That could be caused by GERD or really any insult to the esophagus.
I think scleroderma and Sjogren's tops it off, but given your history those are probably unlikely.
edit: Actually, could it be scleroderma? The tooth thing fits, and the GERD from scleroderma could cause Barrett's. Check your dad's fingernails - is the skin around the nails narrowed so the nail is practically the whole distal finger? Does your dad have a thing where his hands turn shades of blue, white, and red in the cold? Does your dad have spidery blood vessels on the skin? Thick and/or shiny patches of skin, especially round the mouth? It's a pretty rare thing but it's possible.
Uh, so recommendations:
See your doctor - this is an alarm symptom, and generally anything that worsens rapidly is a bad thing. You may have to do things like an endoscopy, esophageal biopsy, barium swallow, or other imaging and tests like an esophageal motility study, which is usually done when the others have come up empty. If your doc is a good gastro or knows one you're in good hands. He might even get surgery depending on what is found, so prepare for that if it comes to it.
There's really not much you can do yourself except find any way that works to get nutrition. If it's diffuse esophageal spasm, you could try eating foods of a different temperature and stay away from carbonated beverages. For reducing acid reflux and worsening Barrett's, stay away from chocolate, greasy foods, peppermint, caffeine, alcohol, acidy juice, and that soda I mentioned earlier, cause your stomach doesn't like that stuff, and you can be double sure that your stressed out esophagus wouldn't like it either. If it's anything else, chew food really thoroughly and wash it down with lots of fluid. Not stressing out could also help - with DES it's not all in your head, actual things are going on down there due to stress. It could all just go away too, but only your doctor could tell you the chances of that.
IANAD and I don't know a single doctor who would give public prescription anyway. These are just mild recommendations that you should throw away immediately when you get a proper advisement from your doctor, and you are encouraged to do your own research with the assumption that anything or everything I say is wrong. Don't let any musing freak you out or stress you; medicine is all about ruling out the nightmare scenarios that you probably never see in a hundred years.
Um, NCBI article in case you want to get educated about Barrett's and dysphagia:
http://www.ncbi.nlm.nih.gov/pubmed/3966636
Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
@DrFrylock, @Paladin et al have said this already, but just to add further encouragement. Dysphagia and Barretts can be a precursor to oesophegal cancer, which if not detected early has an (unfortunately) incredibly high mortality rate, in a very short time. Speaking from experience, encourage your father to go and get a biopsy as soon as possible. You want to get oesophegal cancer detected very early, if it is there, and you want to know it's off the table if it isn't.
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Yeah, this is what my grandpa died of a couple years back. Suddenly went from being in decent health to getting the difficulty he was having swallowing checked out to very VERY sick to... yeah. He took a really quick downturn that nobody expected. And all this while I was out of the country for a couple months. So yeah, seriously, be on top of this. Make sure he gets all the tests he can.
Same here, in the space of about 40 days my grandfather went from perfectly healthy for an 80 year old man to no longer with us.
If you need to scare the shit out of your father to get him in to the doctor's office, do it. This is not something to put off even for a single day.
True, But if the dysphagia is new development, between scopes, it's something that needs to be highligted to the healthcare provider ASAP. It's not something to ignore in the hope it will get better on its own, because that can (unfortunately) end with a stent in your throat. I don't think anyone here is trying to be alarmist, but this is something that can, potentially, be nothing (comparatively), but can also be very serious.
OP: Seriously, IANAD, but highly recommend your father sees *his* MD as soon as is practical. 'Toughing it out' is not practical, as it may need actual medical treatment to get better, and could get worse very quickly, especially with Barrett's as a precuror.
The short term solution is easily chewable/swallowable foods (rice, mince, porridge, for example), and, if especially bad, ice cubes for numbing and as an alternative to drinking. But this is not a proper solution. That's something you're going to need a doctor for.
Incidentally: Given the Barretts, the dysphagia is probably not psychological. In which case, as it is impeding function, it needs to be looked at in any case. ABove resonders and I are just saying this should be done *very much* sooner rather than later.
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The good news is that he turned up negative on all three tests, so we can rule out cancer.
The bad news is that his eating habits are getting worse. On some days he can't even manage soup, claiming that there's a tightness in his throat like he had eaten too much spice. The next step is to find a new dentist, as he's convinced his problem has to do with his dentures. He claims that his top row of teeth feel off, and with his esophagus ruled out, that's likely the main cause.
Continuing to look for tips on the next course of action we should take.
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By swallowing test, did you mean a barium swallow, which would be a bright liquid going down a CT scan looking view at his esophagus, or a motility study, which is a chart with a bunch of waves that tracks the pressures at different parts of his esophagus? Cause if there is no obstruction on endoscopy or barium swallow and severe dysphagia persists, a manometry is indicated (unless the dysphagia has already been diagnosed).
Actually, having talked with GI docs about this (remember, IANAD and they're giving advice based on limited information), a pH study to diagnose if he really has acid reflux (which happens most of the time in Barrett's but is not guaranteed) would be a good idea, because once that's established, it might be a good idea to mix up the dosage/type of PPI he's receiving, or consider surgery.
The treatment for GERD and its related symptoms is a PPI and/or surgery. People who respond well to PPI respond well to surgery, but there are different types of PPIs that work/don't work on different people. If the dysphagia is severely affecting his quality of life, the PPI is not working, and stronger/different intervention is necessary. Make sure the doctor knows how much this symptom is affecting his quality of life and the doc should change up the treatment regimen.
In the meantime, does your dad chew gum? A learned behavior people with weak esophageal motility will do is chew gum or suck lozenges to perpetually swallow all the time and clear acid/food from a reflux esophagus a little bit at a time chronically. This also works for stroke patients who develop the same symptoms. It's a minor alleviation but it has some grounding in science, and shouldn't be a substitute for actual treatment.
But yeah, the omeprazole isn't working hard enough, and if he hasn't experimented with other drugs yet, he should (IANAD).
Just for my own curiosity, does he have skin tightness around his fingers, and do they change color in the cold? Does he have small red spidery blotches that appear over his body? Does he have hard calcifications in his fingertip?
Does he have diabetes?
Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
Er, if he still has Barrett's as was diagnosed earlier (as opposed to those tests showing that in particular negative) then he still has a chronic issue with his esophagus, even if there's no cancer. He may have a problem with his dentures and isn't chewing correctly, but if he's having trouble with soup it sounds like he still has problems with the esophagus. Just that there are other things beyond just cancer that will cause that.