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Gastroenterology  (Expert Forum)
 | 
esophagitis
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

esophagitis

by gtseshan, Mar 09, 2003 12:00AM
I have had acidity problems before and had been treated for Hpylori about 5 years back. I was normal, till about 2 months back. I went on vacation for a week, and was eating fried foods and coffee a lot. I came back with diarrehea and bit of abdominal pain. The diarehea went away, but I had bit of heartburn, burning sensation in the stomach and sensation of something sticking in my throat. My doctor gave me PEPCID 40mg, but did'nt help. I went to a gastroentrologist who did an endoscopy. He said there was a minor inflammation in the esophagus possibly due to GERD. Nothing else. Biopsy of the tissue was negative. He put me on PREVACID 30mg. That only worsened my problem. In additon I started having abdominal pain possibly due to ingidestion. So, I stopped it after a week. I tried Zantac 75, and it worked. Prescription strength Zantac has worked for me before. So, I said this to my gastroentrologist and he prescribed Zantac 150, twice a day.

My question is, is it ok to take Zantac continuously. Also,my doctor says that, if left untreated this would lead to Barrets esophagus. I cannot handle PREVACID or PRILOSEC either. I am 37, 160lbs, married with a kid.
Doctor's Answer

by Kevin Pho, MD, Mar 09, 2003 12:00AM
Hello - thanks for asking your question.  



It is definitely true that untreated GERD can lead to Barretts esophagus.  Chronic acid reflux leads to a change in the cells of the esophagus (i.e. squamous to intestinal epithelium).  The intestinal epithelium is more prone to transform to cancer.



Zantac is part of the class of drugs known as H2-receptor antagonists (H2RAs), which inhibit acid secretion in the stomach.  It is safe to use over the long term - in over 13 years of use, Zantac's safety profile has been confirmed in over 220 million patients.  Headache, sometimes severe; abdominal discomfort/pain; nausea and vomiting; constipation; and diarrhea are the reported side effects that have been noted in studies.



CNS side effects were one of the rarely-noted side effects over the long term:

H2RAs can cause confusion, restlessness, somnolence, agitation, headaches, and dizziness and, with prolonged therapy, hallucinations, focal twitching, seizures, unresponsiveness, and apnea. These symptoms are reversible upon discontinuation of the drug.



Some people do not prefer taking medication indefinitely.  One option would be to consider surgical options for your reflux.  You may want to discuss this with your personal physician.  



Followup with your personal physician is essential.



I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (19)

by tessa0825, Mar 09, 2003 12:00AM
Hello, as for progressing to Barretts, I think it is a VERY LOW percentage of people that actually progress from esophagitis to Barretts, although there seems to be alot of confusion surrounding who does and who doesnt...I have Barretts but I was never diagnosed with GERD until it had progressed to Barretts..I totally ignored all my symptoms, thinking that everyone had these things happening. I only saw a GI SPec. after my family Dr. started a search and find mission because of unexplained high white blood cell counts.. Eventually I was sent to cancer Drs. and then to GI Spec...I complained about NOTHING and was completly shocked when my first EGD showed , severe erosions, strictures, lg hiatal hernia, and three active ulcers....It was about 4 months later when the ulcers were healed and the strictures dilated that he could do Biopsies confirming the Barretts diagnosis...The thing about esophagitis is that you have to stop the damage at you starting point..mine was already Barretts from our starting point, so we have to do everything we can such as taking PPIs, staying on GERD diet, using wedge pillow, and having regular EGDs and biopsies to check for progression and deal with problems as they occur....I dont know why your Dr. would scare you by telling you that you WOULD progress to Barretts because most people NEVER do...You just have to control the acid and stop the damage....Take care.....Tessa

by tessa0825, Mar 09, 2003 12:00AM
Hello, there are many GOOD sites on the web about Barretts if you want to become more familar with them...John Hopkins has a really good site and also medicinenet.com has tons of info about Barretts as does webmd...You do know and realize that Barretts can only be diagnosed by biopsy? and then most people get a second opinion....GERD "CAN" lead to Barretts but the key word is "CAN". That is why it is important to stop the damage from progressing,and it is absolutely important to follow your Drs. orders and to take some responsibility for your diagnosis yourself....Follow the GERD diet, raise the head of the bed, take your meds, and continue surveillance through regularly scheduled EGDs......Good Luck........Tessa....check out this site....http//www.medicinenet.com/Barretts_Esophagus/pg1htm

by joi, Mar 10, 2003 12:00AM
Ihave gerd and am at my wits end..I have the constant food sticking, food sitting in thorat feeling and constant regurgation when I burp..I can't stand this anymore it has been non stop since november..I am on nexium 2x a day and reglan w/ dinner..I had a barium swallow that showed reflux but no obstructions and am being scoped next week..basically since I'm not respondin to meds I am going to try to change my diet..what can I eat?? right now I think I'm better of not eating at all because it sits in my chest like a big lump..

by gtseshan, Mar 10, 2003 12:00AM
I am at my wits end too. I just cannot get rid of this "food stuck in my throat" problem. It is very bad till about noon. Once I have lunch, it starts getting better and its almost gone by evening. It starts all over again once I wake up. I do not have much of a heartburn, but its more of a stomach burn and overall discomfort in the mid - lower abdomen. Somebody, in a different thread had suggested taking anti-depressant since it had helped. My gastroentrologist prescribed it too, but I tossed it out, lest I get addicted to anti-dpressants.

by joi, Mar 10, 2003 12:00AM
To: gtseshan
does it feel like the food just sits at the bottom of your throat after you eat? do you feel like certain foods like bread stick going down? does your food come back up when you burp../this lump is the worst thing I've had to live w/ the last 3 months I can't stand it anymore

by beccabond, Mar 10, 2003 12:00AM
To: gtseshan
You might want to reconsider taking the anti-depressant your gastroenterologist prescribed for you.  I don't have GERD, but my gastroenterologist found gastritis after I had an upper endoscopy done.  He prescribed me prescription Zantac and advised me to change my diet.  I did both of these things, but I was getting worse instead of better.  Three weeks ago he prescribed an anti-depressant, Doxepin, which he said was to help me sleep.  The though of taking an anti-depressant made me nervous.  I didn't feel depressed (other than I was tired of being sick), and I didn't want to get hooked on something since I've never taken an anti-depressant before.  I started taking the Doxepin, though, and the next day I immediately felt better.  I got a great nights sleep (because it does make you very sleepy), and I was able to eat again.