All About My Ass

Not really -- like I'd write about my ass on my blog?

I did want to give all my interested readers the results of my GI evaluation from last month, which consisted of an upper endoscopy and a sigmoidoscopy (aka: cameras in both ends).

"The upper endoscopy showed normal esophageal mucosa. There was a hiatus hernia with a hyperplastic-appearing polypoid tissue on the gastric side of the GE junction. This was biopsied and showed intestinal metaplasia. There was marked gastritis in the body of the stomach. This was also biopsied. The duodenum was normal. The colonic mucosa was normal, except for one area in the rectum {sorry that's graphic!}, which was biopsied to rule out proctitis and only showed non-specific changes."

He doesn't say what all this means, except that I'm basically fine. Actually something which I perceive to be kind of cool is happening, which is that some of the cells in my stomach have changed to intestinal cells (I'm a mutant!). You can read more about it, here. It supposedly puts me at a higher risk for cancer, according to that link, which is I think why the doctor recommends that I have another endocsopy (the down the throat one) in a year.

I feel like his comments aren't that clear, though, because there were actually three biopsies, and the one of the GE junction (the part he wants looked at in another year) says that I have chronic carditis with focal intestinal metaplasia, and also notes the presence of attached esophageal squamous epithelium.

Now, I'm no doctor, but I'm guessing from this article that he was able to eliminate Barrett's (basically a messing-up of the lower lining of the esophagus, thanks to too much acid, where stomach cells begin to grow in the lower part of the esophagus, and that correlates with cancer -- see here for more info) by the fact that the metaplasia that was observed did not correlate with the area of carditis. I believe, and I could be totally wrong here, that basically the area that is so irritated by acid (which is the area of concern) and the area that is showing the wrong cells in the wrong place are not correlated to a degree that they think I have Barrett's (I should write a new blog where people without any medical training speculate about what pathologists are thinking when they analyze things!). If you look at those articles and then look back at the quote from the doctor's letter, it looks like the metaplasia I have is intestinal cells growing on the stomach-side of my GE junction, which doesn't worry them, because Barrett's related metaplasia would be stomach cells growing on the esophageal-side of my GE junction (aka: you have inflammation related to acid, but the wrong cells growing in the wrong place that can result from that and be bad you DON'T have -- you have the wrong wrong cells growing in the wrong wrong place).

My concern, then, is that he doesn't say anything about H-pylori infection, which can be another reason for the carditis and metaplasia. From what I understand from this article, H-pylori infection is super common, though, and the treatment the doctor recommended for my overly-acidic stomach would basically be what would be used to treat H-pylori infection anyway...I just wish it would have been looked at to see if I have it!

Basically the doctor is keeping an eye on the GE junction (which I'm guessing stands for gastro-esophageal?) to make sure I don't develop Barretts or esophageal cancer, but isn't too worried.

In lower GI news :), I'm also not crazy about thinking there is an abnormal amount of mucous, since the biopsy from down there says that I have "colorectal mucosa with non-specific inflammation, congestion and reactive-type changes" (which basically means: "we're not sure what is going on, but we think it's within the range of normal and just eat more fiber). The good news is that he's confident that I don't have colitis. YAY!

I haven't been taking the Prilosec that he recommended, because I haven't been that symptomatic, acid-wise (except the past two days, when I did take it), but in this letter that he supposedly wrote a month ago but I just got he says to take it every other day even when I don't need it every day to treat symptoms. I guess this is because we're really serious about not damaging the lower part of the esophagus (interestingly, if you read all the links, you'd see that people with Barretts often experience decreased symptoms related to the dysplasia at the GE junction, in part because the stomach cells growing up in the lower part of the esophagus are, like all stomach cells, acid resistant, so a person with stomach cells in their esophagus can't feel the acid reflux as acutely).

Medicine is awesome, and I'm awesome that I can sift through this stuff at nearly 4AM.

VC