Help Understanding Recent EGD report

[tessa0825]

Dr. Pho,
Thank-you for this forum and for allowing me to ask these questions...I'am a little more than 3 months post esophageal surgery (collis/nisen). I recently had a follow-up EGD for my local GI to eval. the surgery..I originally was scheduled to have post-op ph studies, however, because of situations, my local GI decided to not do ph studies but rather the EGD..I received a copy of my EGD report and Im confused in some areas..It states....Pt. has significant gastritis. Biopsies were taken for CLO test. Recent surgery could be seen. it seems to be a reasonable surgery. the pt. has a relatively longer tunnel in the distal esophagus, however, there is now endoscopic esophagitis at all patches of that, it was seen; again, biopsies were taken.
Rocommendations: If HP is positive, it is going to be treated. As soon as pt has symptoms,PPI should be restarted. Diet restrictions should still be continued and she is going to have repeat EGD in 6 months for evaluation of her Barrett's esophagus and lgd.
My Questions: 1. What is he saying in reference to this esophagitis in the new area? Im interpreting it to mean that the portion of stomach used had gastritis which is now esophagitis? If that is so, what is the implications of that, for my Barrett's esophagus? 2.He also verbally told my husband that he thought disc. of PPI would be a short duration. One of the reasons I choose this surgery was to disc. PPI. I dont understand this reasoning? 3. He has started me back on GERD diet which I was told, by my surgery, to not follow post-op, but to begin adding back all the foods I had given up..Why would he want me back on that diet? 4. In light of this and this report, was my surgery a failure?
I have the stomach path report back and HP was negative..Esophageal path report is not avail yet...Im also taking what I think is a brutal regime of anti-inflammatories (Prednisone 4x daily and weekly MTX) as soon as my Dr. gets ins. clearance I will also start ebrel(sp) injections...I never have HP but this gastritis never goes away..Any light you can shed will be appreciated...

[Kevin Pho, MD]

Hello - to answer your questions:
1) It may be possible that it may be new areas of esophagitis if the fundoplication is still allowing some reflux.  As for the implications to the Barrett's esophagus, the only way to make sure it isn't worsening would be serial biopsies.

2) If the fundoplication continues to allow some reflux, a short course of PPIs may still be needed.  As you know, the best way to tell would be the 24-hr pH study.  

3) I would assume that he is putting you back on the diet, to try and help alleviate any possible remaining reflux.  With the surgery, the hope is that the reflux can be reduced to managable symptoms.  

4) I cannot say for sure whether the surgery was a failure.  You may need more time for further evaluation.  A 24-hr test (if that is possible) would be the definitive test to see if the reflux remains or not.  In the meantime, you may want to discuss whether a short course of Nexium can reduce the symptoms.  With your regimen of anti-inflammatories, you will be prone to GI inflammation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[tessa0825]

Thank-you very much for your suggestions and advise, I appreciate it...Tessa

[tessa0825]

I spoke with my GIs assistant this morning. My biopsies are in..She told me they showed alot of inflammation in the new area with changes of reflux...Good news, I guess, is that area of samples didnot show any intestinal metaplasia or dysplasia..Iam restarting Nexium today...Should I pursue PH studies at this time to see just how bad this reflux still is? The reason my Gi decided to do an EGD and look around instead of ph studies is that I didnot tolerate this test at pre-op eval. It took the Dr. 4 tries to even get the tube in proper placement and then I gagged the entire 24 hrs. which inhibited activity and eating thus compromizing the results...He noted on the report that I should never have this test repeated, but rather have bravo testing...Bravo isn't avail. to me locally,  I would have to drive round trip of 400 miles to have this test....Or, should I just take my nexium, go back on reflux diet, and wait until next EGD in 6 months..I'm really bummed out right now! thanks, Tessa