Upper Esophagus Acid Reflux 
Author Message
 Upper Esophagus Acid Reflux

Hi.. I have the kind of of Reflux that only affects the Upper Esophagus  
(bad taste in mouth, sinus reactioj). Will putting the head of my bed up
6" help or does this only help for other kinds of reflux. I only ask
because it actually seems my reflux goes away when lying down.

thanks



Fri, 06 Jan 2006 07:35:16 GMT
 Upper Esophagus Acid Reflux
Actually, there is no such thing as acid reflux that affects only the upper
esophagus, since the refluxate has to go by the lower esophagus to get to
the upper esophagus. What you probably mean is that your most severe
symptoms are in the upper esophagus.

The problem is that the refluxate may be causing damage to the lower
esophagus even though you are not having symptoms located there. That damage
may include stricture, or pre-cancerous Barrett's esophagus. To make matters
even worse, successfully treating the symptoms by suppressing the acid
reflux with {*filter*} such as Nexium or Tagamet may not affect the risk of
esophageal cancer since those {*filter*} will still allow alkaline reflux, which
may very well continue the pre-cancerous damage to the lower esophagus.

I'd get that looked at if I were you.

HMc


Quote:
> Hi.. I have the kind of of Reflux that only affects the Upper Esophagus
> (bad taste in mouth, sinus reactioj). Will putting the head of my bed up
> 6" help or does this only help for other kinds of reflux. I only ask
> because it actually seems my reflux goes away when lying down.

> thanks



Fri, 06 Jan 2006 11:20:10 GMT
 Upper Esophagus Acid Reflux
Then how do doctors deal with Alkaline Reflux?

Thanks,

R


Quote:
> Actually, there is no such thing as acid reflux that affects only the
upper
> esophagus, since the refluxate has to go by the lower esophagus to get to
> the upper esophagus. What you probably mean is that your most severe
> symptoms are in the upper esophagus.

> The problem is that the refluxate may be causing damage to the lower
> esophagus even though you are not having symptoms located there. That
damage
> may include stricture, or pre-cancerous Barrett's esophagus. To make
matters
> even worse, successfully treating the symptoms by suppressing the acid
> reflux with {*filter*} such as Nexium or Tagamet may not affect the risk of
> esophageal cancer since those {*filter*} will still allow alkaline reflux,
which
> may very well continue the pre-cancerous damage to the lower esophagus.

> I'd get that looked at if I were you.

> HMc



> > Hi.. I have the kind of of Reflux that only affects the Upper Esophagus
> > (bad taste in mouth, sinus reactioj). Will putting the head of my bed up
> > 6" help or does this only help for other kinds of reflux. I only ask
> > because it actually seems my reflux goes away when lying down.

> > thanks



Sun, 08 Jan 2006 07:18:37 GMT
 Upper Esophagus Acid Reflux
Most doctors erroneously treat acid reflux with medicine (proton pump
inhibitors such as Prilosec) and call it good, but this only treats the
symptoms, not the disease itself, by reducing or stopping the
symptom-causing acid in the refluxate. The only way to cure GERD is to
address the cause of the reflux, which is the dysfunction of the lower
esophageal sphincter. This must be done surgically either by Stretta
procedure, or by a laparoscopic gastric fundoplication ("Nissen"
fundoplication). People who have documented GERD and are being treated only
symptomatically with anti-acid medication should be monitored periodically
by upper GI endoscopy for the development of pre-cancerous Barrett's
esophagus even in the presence of successful symptom resolution.

HMc


Quote:
> Then how do doctors deal with Alkaline Reflux?

> Thanks,

> R



> > Actually, there is no such thing as acid reflux that affects only the
> upper
> > esophagus, since the refluxate has to go by the lower esophagus to get
to
> > the upper esophagus. What you probably mean is that your most severe
> > symptoms are in the upper esophagus.

> > The problem is that the refluxate may be causing damage to the lower
> > esophagus even though you are not having symptoms located there. That
> damage
> > may include stricture, or pre-cancerous Barrett's esophagus. To make
> matters
> > even worse, successfully treating the symptoms by suppressing the acid
> > reflux with {*filter*} such as Nexium or Tagamet may not affect the risk of
> > esophageal cancer since those {*filter*} will still allow alkaline reflux,
> which
> > may very well continue the pre-cancerous damage to the lower esophagus.

> > I'd get that looked at if I were you.

> > HMc



> > > Hi.. I have the kind of of Reflux that only affects the Upper
Esophagus
> > > (bad taste in mouth, sinus reactioj). Will putting the head of my bed
up
> > > 6" help or does this only help for other kinds of reflux. I only ask
> > > because it actually seems my reflux goes away when lying down.

> > > thanks



Sun, 08 Jan 2006 13:31:34 GMT
 Upper Esophagus Acid Reflux

Quote:

> Most doctors erroneously treat acid reflux with medicine (proton pump
> inhibitors such as Prilosec) and call it good, but this only treats the
> symptoms, not the disease itself, by reducing or stopping the
> symptom-causing acid in the refluxate. The only way to cure GERD is to
> address the cause of the reflux, which is the dysfunction of the lower
> esophageal sphincter. This must be done surgically either by Stretta
> procedure, or by a laparoscopic gastric fundoplication ("Nissen"
> fundoplication). People who have documented GERD and are being treated only
> symptomatically with anti-acid medication should be monitored periodically
> by upper GI endoscopy for the development of pre-cancerous Barrett's
> esophagus even in the presence of successful symptom resolution.

> HMc



> > Then how do doctors deal with Alkaline Reflux?

> > Thanks,

> > R



> > > Actually, there is no such thing as acid reflux that affects only the
> > upper
> > > esophagus, since the refluxate has to go by the lower esophagus to get
> to
> > > the upper esophagus. What you probably mean is that your most severe
> > > symptoms are in the upper esophagus.

> > > The problem is that the refluxate may be causing damage to the lower
> > > esophagus even though you are not having symptoms located there. That
> > damage
> > > may include stricture, or pre-cancerous Barrett's esophagus. To make
> > matters
> > > even worse, successfully treating the symptoms by suppressing the acid
> > > reflux with {*filter*} such as Nexium or Tagamet may not affect the risk of
> > > esophageal cancer since those {*filter*} will still allow alkaline reflux,
> > which
> > > may very well continue the pre-cancerous damage to the lower esophagus.

> > > I'd get that looked at if I were you.

> > > HMc



> > > > Hi.. I have the kind of of Reflux that only affects the Upper
> Esophagus
> > > > (bad taste in mouth, sinus reactioj). Will putting the head of my bed
> up
> > > > 6" help or does this only help for other kinds of reflux. I only ask
> > > > because it actually seems my reflux goes away when lying down.

> > > > thanks

Sometimes the cure is worse than the disease.  No one should just
casually have surgery because "that's the only way to cure the
disease."  The vast majority of people with GERD will NOT benefit from
surgery.


Mon, 09 Jan 2006 09:59:12 GMT
 Upper Esophagus Acid Reflux


Quote:

> Sometimes the cure is worse than the disease.  No one should just
> casually have surgery because "that's the only way to cure the
> disease."  The vast majority of people with GERD will NOT benefit from
> surgery.

I never suggested that that was the case. GERD doesn't NEED to be cured
unless the patient's symptoms are not manageable with medication and/or
lifestyle changes, or unless they have Barrett's esophagus, and EGD
monitoring shows a tendency toward dysplasia.

The vast majority of people who fall into the above category will most
definitely benefit from anti-reflux surgery, both in terms of lifestyle
improvement, and in terms of esophageal cancer risk moderation.

HMc



Mon, 09 Jan 2006 10:20:29 GMT
 Upper Esophagus Acid Reflux


Quote:
> Most doctors erroneously treat acid reflux with medicine
(proton pump
> inhibitors such as Prilosec) and call it good, but this
only treats the
> symptoms, not the disease itself, by reducing or stopping
the
> symptom-causing acid in the refluxate. The only way to
cure GERD is to
> address the cause of the reflux, which is the dysfunction
of the lower
> esophageal sphincter. This must be done surgically either
by Stretta
> procedure, or by a laparoscopic gastric fundoplication
("Nissen"
> fundoplication). People who have documented GERD and are
being treated only
> symptomatically with anti-acid medication should be

monitored periodically

Quote:
> by upper GI endoscopy for the development of pre-cancerous
Barrett's
> esophagus even in the presence of successful symptom
resolution.

> HMc

Yes, but please don't imply that you'll still get Barrett's
esophagus and cancer even if you block acid with {*filter*} and
antacids. Surgery is slightly better than {*filter*} in blocking
new lesions only because the drug therapy isn't perfect. It
can be improved. So far as preventing dysplasia and cancer,
surgery and medical therapy are so similar one cannot really
be preferred from that viewpoint. And the surgery is a {*filter*}
one, with reasonably high morbility and mortality.

      Ann Surg. 2003 Mar;237:291-8.

Long-term results of a randomized prospective study
comparing medical and surgical treatment of Barrett's
esophagus.

Parrilla P, Martinez de Haro LF, Ortiz A, Munitiz V, Molina
J, Bermejo J, Canteras M.

Department of Surgery, University Hospital Virgen de la

OBJECTIVE: To compare the results of medical treatment and
antireflux surgery in patients with Barrett's esophagus
(BE). SUMMARY BACKGROUND DATA: The treatment of choice in BE
is still controversial. Some clinical studies suggest that
surgery could be more effective than medical treatment in
preventing BE from progressing to dysplasia and
adenocarcinoma. However, data from prospective comparative
studies are necessary to answer this question. METHODS: One
hundred one patients were included in a randomized
prospective study, 43 with medical treatment and 58 with
antireflux surgery. All patients underwent clinical,
endoscopic, and histologic assessment. Functional studies
were performed in all the operated patients and in a
subgroup of patients receiving medical treatment. The median
follow-up was 5 years (range 1-18) in the medical treatment
group and 6 years (range 1-18) in the surgical treatment
group. RESULTS: Satisfactory clinical results (excellent to
good) were achieved in 39 of the 43 patients (91%)
undergoing medical treatment and in 53 of the 58 patients
(91%) following antireflux surgery. The persistence of added
inflammatory lesions was significantly higher in the medical
treatment group. The metaplastic segment did not disappear
in any case. Postoperative functional studies showed a
significant decrease in the median percentage of total time
with pH below 4, although 9 of the 58 patients (15%) showed
pathologic rates of acid reflux. High-grade dysplasia
appeared in 2 of the 43 patients (5%) in the medical
treatment group and in 2 of the 58 patients (3%) in the
surgical treatment group. In the latter, both patients
presented with clinical and pH-metric recurrence. There was
no case of malignancy after successful antireflux surgery.
CONCLUSIONS: These results show that there are no
differences between the two types of treatment with respect
to preventing BE from progressing to dysplasia and
adenocarcinoma. However, successful antireflux surgery
proved to be more efficient than medical treatment in this
sense, perhaps because it completely controls acid and
biliopancreatic reflux to the esophagus.

Publication Types:
  a.. Clinical Trial
  b.. Randomized Controlled Trial

PMID: 12616111 [PubMed - indexed for MEDLINE]



Wed, 18 Jan 2006 07:31:12 GMT
 Upper Esophagus Acid Reflux


Quote:
> Most doctors erroneously treat acid reflux with medicine
(proton pump
> inhibitors such as Prilosec) and call it good, but this
only treats the
> symptoms, not the disease itself, by reducing or stopping
the
> symptom-causing acid in the refluxate.

It's not an error. It not only treats the symptoms, but also
the side effects down the line. You can die from the
surgery. There is no evidence that anybody dies from
decision to have drug treatment RATHER than surgery.

In such a case, talk about curing the disease or the
symptoms is silly. What you want is not to die.

SBH



Wed, 18 Jan 2006 07:47:55 GMT
 Upper Esophagus Acid Reflux


Quote:



> > Most doctors erroneously treat acid reflux with medicine
> (proton pump
> > inhibitors such as Prilosec) and call it good, but this
> only treats the
> > symptoms, not the disease itself, by reducing or stopping
> the
> > symptom-causing acid in the refluxate.

> It's not an error. It not only treats the symptoms, but also
> the side effects down the line. You can die from the
> surgery. There is no evidence that anybody dies from
> decision to have drug treatment RATHER than surgery.

> In such a case, talk about curing the disease or the
> symptoms is silly. What you want is not to die.

> SBH

The relationship between alkaline reflux and esophageal cancer is well
studied and documented (http://tinyurl.com/4pta). Antireflux surgery is the
only method of preventing this, whereas as anti-secretory medication
exacerbates the problem by augmenting the precipitation of carcinogenic bile
salts in the stomach.

Treating the symptoms of acid reflux is fine if those symptoms are indeed
adequately treated and there is no evidence of end-stage GERD (Barrett's
esophagus). If there is, than such half-measures are inadequate.

HMc



Wed, 18 Jan 2006 09:41:25 GMT
 Upper Esophagus Acid Reflux


Quote:
> Treating the symptoms of acid reflux is fine if those
symptoms are indeed
> adequately treated and there is no evidence of end-stage
GERD (Barrett's
> esophagus). If there is, than such half-measures are
inadequate.

> HMc

The abstract I posted shows you are wrong. Now it's your
turn to post randomized studies supporting your conclusion.

Good luck.



Thu, 19 Jan 2006 01:47:42 GMT
 Upper Esophagus Acid Reflux


Quote:



> > Treating the symptoms of acid reflux is fine if those
> symptoms are indeed
> > adequately treated and there is no evidence of end-stage
> GERD (Barrett's
> > esophagus). If there is, than such half-measures are
> inadequate.

> > HMc

> The abstract I posted shows you are wrong. Now it's your
> turn to post randomized studies supporting your conclusion.

> Good luck.

I confess I didn't work very hard at completing your assignment, Steve. I
didn't really find any randomized studies. However, I am dismayed that you
give so much credence to the concept of drawing meaningful conclusions about
treatment of GERD relative to esophageal cancer based on a study with a mean
followup of 6 years. Until an ADEQUATE randomized prospective study comes
along, I am going to rely on the science of the subject.

HMc

Immunohistochemical study of p53, c-erbB-2, and PCNA in barrett's esophagus
with dysplasia and adenocarcinoma arising from experimental acid or alkaline
reflux model.

Kawaura Y, Tatsuzawa Y, Wakabayashi T, Ikeda N, Matsuda M, Nishihara S.

Department of Surgery, Ishikawaken Saiseikai Kanazawa Hospital, Japan.

PURPOSE: An immunohistochemical study of p53, c-erbB-2, and proliferating
cell nuclear antigen (PCNA) in Barrett's esophagus with dysplasia and
adenocarcinoma, arising from experimental acid or alkaline reflux, was
performed in dogs. METHODS: Cardiectomy was performed in group A (n = 26) as
an acid reflux model, and total gastrectomy was performed in group B (n =
24) as an alkaline reflux model. After surgery, the esophageal mucosa was
observed and biopsied endoscopically every 3 months over a period of 6
years. Immunohistochemical staining of p53. c-erbB-2, and PCNA was
performed, using biopsied specimens. RESULTS: In group A, Barrett's
esophagus developed in 14 of the 26 dogs. Low-grade dysplasia occurred in 5
of the 26 dogs, and in 1 of these 5 dogs, it developed into high-grade
dysplasia. In this animal, adenocarcinoma arose 63 months after the
operation. In group B, Barrett's esophagus developed in 10 of the 24 dogs.
Low-grade dysplasia was observed in 4 of the 24 dogs. In 1 of these 4 dogs,
the dysplasia became high-grade and adenocarcinoma occurred 66 months after
the operation. In group A, PCNA was positive in adenocarcinoma; the PCNA
labeling index (LI) was 58. c-erbB-2 and p53 were negative in all animals in
group A. In group B, PCNA was positive in Barrett's esophagus with
high-grade dysplasia and adenocarcinoma; the PCNA LI was 77. p53 was
positive in adenocarcinoma. c-erbB-2 was negative in adenocarcinoma.
CONCLUSIONS; The results of this study provided evidence of the
dysplasia-carcinoma sequence arising from alkaline reflux, as well as from
acid reflux. To the best of our knowledge, this is the first report of the
use of an alkaline reflux model and a 6-year study using dogs to observe the
course of Barrett's esophagus.

[Adenocarcinoma of the esophagogastric junction: association with Barrett
esophagus and gastroesophageal reflux--surgical results in 122 patients]

[Article in German]

Schumpelick V, Dreuw B, Ophoff K, Fass J.

Chirurgische Klinik, Medizinischen Fakultat, Rheinisch-Westfalische
Technische Hochschule (RWTH), Aachen.

OBJECTIVE: To investigate the surgical results of adenocarcinoma of the
esophagus and esophagogastric junction and its relationship with
gastroesophageal reflux disease (GERD) and Barrett's esophagus. Background:
The incidence of adenocarcinoma of the cardia is continuously rising.
Specialized intestinal metaplasia in Barrett's esophagus seems to be the
source of these tumors. Barrett's esophagus is end stage GERD. In
experimental studies alkaline reflux give rise of Barrett's esophagus and
adenocarcinoma. PATIENTS: 122 patients with adenocarcinoma of the cardia and
 121 patients with squamous cell tumor of the esophagus. METHODS: All
esophageal resections between 11/85 and 2/95 were retrospectively analyzed.
The relationship of gastroesophageal reflux disease, Barrett's esophagus and
malignancy was compared between both groups using parameters of case history
and histological sections. Survival was analyzed for tumorstage, T-and
N-stage and R-classification. RESULTS: 5.9% of the adenocarcinomas were
stage I, 44.1% stage II, 41. 5% stage III and 8.5% stage IV. Heartburn,
regurgitation, consumption of H2 blockers or Barrett's mucosa were
significantly more frequent for adenocarcinomas. A 5 year survival of 100%
was seen for stage I tumors. Invasion of t he muscular layer reduced
survival to 50%, lymph node invasion to 20%. R0-resection had a survival of
40%. CONCLUSIONS: A relationship of GERD and adenocarcinoma of the cardia
seems to be likely in our cases. Most patients had advanced malignancy.
Survival is good only for early cases. Prevention of tumor genesis with
effective antireflux surgery in case of alkaline reflux seem to be the best
therapeutic decision.

Increased expression of epidermal growth factor receptors in Barrett's
esophagus associated with alkaline reflux: a putative model for
carcinogenesis.

Jankowski J, Hopwood D, Pringle R, Wormsley KG.

Department of Medicine, Dundee University.

A 49-yr-old male was reviewed who had a 10-yr history of reflux esophagitis.
He presented initially with frequent heartburn of moderate severity and, on
subsequent endoscopy, was noted to have erosive esophagitis and, at that
time, a high maximal gastric acid output. During the next 5 yr, his symptoms
and acid output diminished. Eight years after presentation, he was noted to
have developed a small area of Barrett's metaplasia, without dysplastic
change. Ten years after the initial presentation he was completely
asymptomatic, despite having extensive Barrett's metaplasia, now with high
grade dysplasia. As a result, he was referred for esophagogastrectomy. At
the time of surgery, he had alkaline reflux, with antacid gastric contents
and, subsequently, hypochlorhydria was proven by a pentagastrin test. A
second individual (male, 46 yr) who presented initially with reflux symptoms
and gastric-type metaplasia, underwent gastric secretory studies that
revealed a peak acid output of 16 mmol/L in 1986. During the period 1989 to
1991, his symptoms progressed despite H2 antagonist therapy. In this regard
he was reinvestigated, and his peak acid output in 1991 was 0 mmol/L, and
subsequent esophageal biopsies demonstrated intestinal metaplasia in four of
six biopsies (two biopsies had high-grade dysplasia; the two others had
gastric-type metaplasia). He has refused esophageal resection, and is being
reviewed regularly at the endoscopy clinic. Flow cytometric analysis of the
esophagus in both individuals revealed expression of epidermal growth factor
receptor which was increased in the areas of high grade dysplasia, compared
with Barrett's mucosa without dysplasia or normal cardiac mucosa. We
conclude that alkaline reflux may accelerate the development of Barrett's
esophagus (and intestinal type metaplasia) in patients with gastroesophageal
reflux disease. The increased expressed of epidermal growth factor receptors
in Barrett's mucosa with dysplasia compared with Barrett's mucosa without
dysplasia may reflect the higher malignant potential of the former mucosa.

Surgical therapy in Barrett's esophagus.

DeMeester TR, Attwood SE, Smyrk TC, Therkildsen DH, Hinder RA.

Creighton University School of Medicine, Department of Surgery, Omaha,
Nebraska.

Seventy-six patients with Barrett's esophagus were cared for during a
10-year period. Fifty-six patients (74%) presented with complications of the
disease. There were 20 strictures, 7 giant ulcers, 11 cases of dysplasia,
and 29 patients with carcinoma. In patients with benign disease, 93% had
mechanically defective sphincters and 83% had peristaltic failure of the
lower esophageal body. Esophageal pH monitoring showed excessive esophageal
exposure to pH less than 4 in 93% and excessive exposure to pH more than 7
in 34% of the patients tested. Ninety-three per cent of patients with
excessive alkaline exposure had complications, compared to only 44% with
normal alkaline exposure (p less than 0.01). Gastric pH monitoring, serum
gastrin levels, and gastric acid analysis supported a duodenal source for
the alkaline exposure. Antireflux surgery was performed using Nissen
fundoplication in 30, Belsey partial fundoplication in 3, and Collis-Belsey
gastroplasty in 2. Six required resection with colon interposition. Good
symptomatic control was achieved in 77% after antireflux surgery. Four
patients had symptoms and signs of duodenogastric reflux; three required a
bile diversion procedure. Fif{*filter*} patients had an en bloc curative resection
with colon interposition. One patient with high-grade dysplasia on biopsy
was found to have intramucosal carcinoma after simple esophagectomy. Five
tumors were intramucosal, seven were intramural, and four were transmural.
Lymph node involvement occurred only in the latter two. Actuarial survival 5
years after curative resection was 53%. Median survival time for patients
after palliative resection or no resection was 12 months. Study of en bloc
specimens indicated that extent of resection should be adapted to extent of
disease: esophagectomy for intramucosal disease, en bloc esophagectomy with
splenic preservation for intramural and transmural disease. Serum CEA was
useful in detecting recurrent disease after surgery when the primary tumor
stained positively for CEA.

Role of intragastric and intraoesophageal alkalinisation in the genesis of
complications in Barrett's columnar lined lower oesophagus.

Attwood SE, Ball CS, Barlow AP, Jenkinson L, Norris TL, Watson A.

Department of Surgery, Royal Lancaster Infirmary.

Patients with ...

read more »



Thu, 19 Jan 2006 04:52:12 GMT
 Upper Esophagus Acid Reflux


Fri, 19 Jun 1992 00:00:00 GMT
 Upper Esophagus Acid Reflux

Appreciate that data is incomplete as to the outcomes of medical vs surgical
treatment of GERD but hopefully lifestyle measures may have some value as they
do in other cancers-- eg etoh avoidance, good diet, not smoking, etc.
Pete



Sun, 22 Jan 2006 02:12:11 GMT
 Upper Esophagus Acid Reflux


Quote:



> Appreciate that data is incomplete as to the outcomes of medical vs
surgical
> treatment of GERD but hopefully lifestyle measures may have some value as
they
> do in other cancers-- eg etoh avoidance, good diet, not smoking, etc.
> Pete

There is reason to be optimistic that  that may be correct. In terms of
esophageal cancer, the point is to stop reflux, not just stop the acid. If
one accepts that up to 80% of reflux episodes are due to transient
inappropriate lower esophageal sphincter relaxation, the lifestyle changes
you mention above, as well as some others, are important since all of those
things ({*filter*}, nicotine, some spicey foods, full stomach) will contribute
to those LES relaxations.

HMc



Sun, 22 Jan 2006 02:26:36 GMT
 Upper Esophagus Acid Reflux


Fri, 19 Jun 1992 00:00:00 GMT
 
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