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#69335 - 07/02/16 11:01 PM Barrett's esophagus
Bert Offline
Admin

Registered: 09/27/03
Posts: 11078
Loc: Brewer, Maine
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?
_________________________
Bert
Pediatrics
Brewer, ME

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#69336 - 07/03/16 02:30 PM Re: Barrett's esophagus [Re: Bert]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1982
Loc: Central Florida
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)?
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John
Internal Medicine

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#69338 - 07/03/16 06:26 PM Re: Barrett's esophagus [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11078
Loc: Brewer, Maine
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.
_________________________
Bert
Pediatrics
Brewer, ME

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#69341 - 07/04/16 02:27 PM Re: Barrett's esophagus [Re: Bert]
JBS Offline
Member

Registered: 09/20/09
Posts: 2448
Loc: Baltimore, MD
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
GI
Baltimore

Reduce needless clicks!

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#69343 - 07/04/16 07:53 PM Re: Barrett's esophagus [Re: Bert]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1982
Loc: Central Florida
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?
_________________________
John
Internal Medicine

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#69344 - 07/04/16 09:15 PM Re: Barrett's esophagus [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11078
Loc: Brewer, Maine
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.
_________________________
Bert
Pediatrics
Brewer, ME

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#69353 - 07/06/16 05:59 PM Re: Barrett's esophagus [Re: Bert]
Boondoc Offline
Member

Registered: 01/13/10
Posts: 997
Loc: Alaska
I wish we had more interesting medical discussions on here, instead of just the usual chart and tech stuff. It's always interesting.
_________________________
Chris
Living the Dream in Alaska

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#69354 - 07/06/16 06:28 PM Re: Barrett's esophagus [Re: Bert]
Greg Phillips Offline
Member

Registered: 03/04/05
Posts: 235
Loc: Coronado,CA
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

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#69356 - 07/06/16 06:54 PM Re: Barrett's esophagus [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11078
Loc: Brewer, Maine
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.
_________________________
Bert
Pediatrics
Brewer, ME

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#69368 - 07/07/16 09:22 PM Re: Barrett's esophagus [Re: Bert]
Boondoc Offline
Member

Registered: 01/13/10
Posts: 997
Loc: Alaska
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.
_________________________
Chris
Living the Dream in Alaska

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#69371 - 07/08/16 04:37 PM Re: Barrett's esophagus [Re: Bert]
ryanjo Offline
Member

Registered: 11/02/06
Posts: 1982
Loc: Central Florida
The anti-vaccine movement is just nature's way of culling the herd. Kind of like voluntary natural selection.
_________________________
John
Internal Medicine

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#69374 - 07/08/16 07:16 PM Re: Barrett's esophagus [Re: Bert]
Bert Offline
Admin

Registered: 09/27/03
Posts: 11078
Loc: Brewer, Maine
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.
_________________________
Bert
Pediatrics
Brewer, ME

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