GERD and Barrett's Esophagus, What In The World Do They Have In Common?

Barretts Espohagus showing cell changes in the esophagus
Barretts Espohagus showing cell changes in the esophagus
normal cells in the esophagus
normal cells in the esophagus
Digestive Tract, picture courtesy of Wikipedia
Digestive Tract, picture courtesy of Wikipedia

Gastrointestional Esophageal reflux Disorder (GERD)

Also known as plain ole "heartburn" this is pain you wish you never met! Left unchecked, the person with reflux will eventually, usually about oh 0200 hours or thereabouts, show up at the nearest emergency room. In the dark ages (LOL), we would prop the poor person's head up on the emergency room table, take their vital signs and start an intravenous drip of Normal Saline and an EKG of course, first thing...then wait. The physician would come out of the sleep room (I worked night shift in rural hospitals a LOT) ruffling the hair on his head, yawning and ask, "Well girls, what do you think?" This is the scenario for heartburn of course. That's pain. It may make you THINK you are having a heart attack but you are not. Heart attack pain makes a person (Usually) go very still and quiet, as if by hiding

the reaper won't notice them.

Macabre, I apologize. Nurses have a weird sense of humor at times, of what is actually proper in polite society.

So if there was no increased blood pressure, no change in skin tone or temperature (shallow, grey and sweaty), no nausea and no abnormal EKG, PVC’s, elevated T waves, increased heart rate, and that button in your brain, that red one, that’s the one, it says “In case of PANIC, PUSH" is not red and pulsing then settle down.

Ah that grasshopper, I often wish I had the ingredients for that famous, two o’clock in the nearest emergency room cocktail. Let's see if this ole nurse can remember all the ingredients...you guys may have to help me on this one.

1. Viscous Lidocaine

2. Mylanta

3. Pepto Bismol

4. Donnatal

5. Take 30 ml of each, pour it all up in a plastic cup, get the person to drink it and wait.

Takes about twenty minutes; if its heartburn the screaming stops; always a good thing in an emergency room of a rural hospital with half a dozen to a dozen real patients down the hall.

I know, I know, time is of the essence, first thirty minutes of a heart attack are the most critical, you are supposed to read the EKG!!! Ship your patient to cath lab! Do lab work! Look important! I thought you were some high falluting twenty some odd old veteran of nursing here! What are you thinking!?

It’s one of those things they neglect to tell you in nursing school. You may actually get one day in a small hospital during school! Wow live it up! Well the real world is different, a lot. Imagine this:

You are on HWY 93, fifty miles in one direction is Kalispell Regional and fifty miles in the other direction is Missoula General Hospital.The place is staffed with four young nurses but you have med surg patients down one hall, maybe a Newborn and Mother, and twelve to twenty geriatric patients dwn another hall. So when those emergency doors burst open and you hear moaning or worse?

Television it is not. It is January in the banana belt, lol. It is cold. The roads are clear, the snowplows and their drivers are really great guys. However, you have one ambulance and they are NOT paramedics. Plus it’s snowing, which is good, a heat wave in the Rockies yippee, at least it’s between 22 and 32 degrees Fahrenheit, but visibility is limited. Your patient is not in any acute danger at this moment; remember the “vital signs and signs of impending in case of panic push, heart attack?” No sweating, no EKG changes, no anxiety, shortness of breath or elevated blood pressure and a much quieter patient.

So much for the diagnosis, poor patient all that pain and then to be told by the physcan "Here, go to the W store or its equivalent and buy a proton pump inhibitor."

This type of medication decreases the amount of acid in your gastrointestinal tract (OK, your stomach). It is used to treat a number of illnesses including GERD, Barretts Esophagus, stress ulcers and ordinary dyspepsia. There is not a lot of definitive work that shows that proton pump inhibitors are actually any better at healing the stomach lining and the esophagus but I absolutely will tell you when I go a week without one, I believe being impaled by gravity over a sharpened stake would be preferable compared to the reflux pain! At least I know my pill of choice, omeprazole (prilosec) is going to work. I don’t have to take it every day but if I go without for a week, it takes three weeks to get back to feeling normal.

How Do You Fix It?

Baby Girl knows exactly how to fix me of course, she is 26 you know, would you like to borrow her?

Lol, sorta.

The thing is she is absolutely correct . She has listened to all of my nursing lectures, she remembers.

· Eat small frequent meals,

· drink plenty of water,

· improve your posture,

· exercise regularly; walking is the best exercise,

· and if there is a specific type of food that makes it worse then avoid it.

· There you go, cured!

I wish. The problem is the harm has been going on for a long time, 56 years of time actually. I have never been able to just get up and eat. I detest water. If it will not get past my nose, it s not going into my mouth. I don’t get hungry until the end of the day; even then, I don’t like to eat a lot of food at one time. Add to all of that I am a nurse. That means (all student nurses do not read this next part)

I drink coffee, any kind, any temperature, at any time I can find the time to slosh it into my cleverly hidden, cleaned every time before I put it away, cup. Other than that, from one task to another, usually without a bathroom break, forget actual food break, I am on my feet from nine to twelve hours a day.

OK, all student nurses may start reading again.

Since I was, let me put this delicately, a bit older when the baby girl (who is still up for grab in case any of you NEED an adult in training?) was born; that means I have been a nurse a little while (cough). Therefore, I take a lot of prilosec. I should buy stock, probably, except that I do not actually approve . Does that make sense? I take it and I take it and all the time I’m worried to pieces about the long term affects of proton pump inhibitors. The first part is to understand what the pill does. It dissolves, like, duh, and by the very last part of the acid production in your stomach, that’s when the prilosec does its thing. It blocks that last stage of acid production, great little idea, eh?

Except that takes away the hydrochloric acid and that takes away your vitamin B12 and calcium. Are you a female of the age that the cute flying nun is addressing? Right, me too. So a broken hip is the risk. Take this wonderful little pill for 1-4 years and your risk of breaking a hip increases 1.2 to 1.6 times that of persons without GERD. The adverse affect that really worries me is Clostridium Difficile. C Diff is a nasty infection, caused by being the last bacteria on the block. The proton pump inhibitor eventually does a great job of clearing out all the bacteria in your intestinal system. All but C Diff. UGH. Enough of that.

What Does This Have To Do With Barretts Esophagus?

There are no special signs and symptoms associated with Barrett’s esophagus. Men are more likely to get it than women, the age is usually over 50, and the number one predisposing factor is GERD has been going on for a long time before Barretts occurs. It is usually diagnosed by upper endoscopy and it is recommended that anyone over the age of 40 who has GERD also have a yearly endoscopy. What the physician is looking for are cell changes in the lining of the esophagus. This change is called intestinal metaplasia, because the tissue that replaces the normal esophageal tissue LOOKS like that of the tissue in your intestines. That’s as far as it goes, usually. For a very small percent of persons with Barretts, less than one percent a year develops esophageal cancer. So, monitor and take your physicians advice and always always take your medications to keep the stomach acid at bay. The risk of a broken hip versus the risk of esophageal cancer…makes buying stock in omeprazole sound rather enticing doesn’t it?

Along with the upper GI series (endoscopy) that your physician recommends biopsies are also taken to check the cells. If a condition known as dysplasia develops the physician may remove the Barrett cells and this fools your body into replacing those cells with normal esophageal cells! How cool is that? This, young student nurses and all you guys out there reading this, was NOT AN OPTION when this writer was…OK OK never mind. It is important though, because so many new and wonderful ways to treat this seemingly innocuous disease are being discovered all the time! I wait for the day when the doctor takes out his palm pilot, runs it down my torso, gives me a pill and I grow a new kidney or a new esophagus! Thank you Bones, oh pardon my over familiarity, Dr.Leonard McCoy!

Until then, whether you have GERD or Barretts Esophagus remember:

1. See your physician regularly.

2. Take all your medications with you, in their bottles, with you to all your physician appointments

3. Do Not Fear the Upper GI Series, you will be sedated, you will be just fine, your nurses will be right there.

4. Take all your medication exactly as the physician orders.

5. Remember that if one pill works then three pills will work better is a LIE !!!!! It will MAKE YOU SICKER !!!! Not to mention it gets you into big trouble with mean nurse kratchets of the world and we are MANY!

6. Last but not least, my adult in training is a being sent to teach me how to be more mature, how to follow my own nursing advice, how to keep going no matter how many times I fail and I cannot live without her near me and her Dad. Besides, she is such a good cook :)

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Comments 17 comments

itakins profile image

itakins 6 years ago from Irl

You are so good at this.I did one on this subj a few weeks ago-pales into insignificance beside this.I have to say as I fall into barrett's group,I do take zoton,but I also take apple cider vinegar (diluted) and honey...when all are dying around me I stand proud and well..great stuff.Now using laser here for barrett's if high grade dysplasia..looking good,I believe.

Excellent hub again


RNMSN profile image

RNMSN 6 years ago from Tucson, Az Author

well itakins, you are the reason I wrote this one/...both you and I must take care!! and the research is fun...I love to teach and I love to learn so if I don't know I will find out :) and I did not know about barretts!! but you and I both will stand proud and well as you say! I tried the vinegar thing but it makes me hurl (can I say that on hb?) haha love to you itakins!


ethel smith profile image

ethel smith 6 years ago from Kingston-Upon-Hull

Love the way you have written this hub. Plenty of info nicely interspersed with some humour. Thanks Nurse Kratchett lol


RNMSN profile image

RNMSN 6 years ago from Tucson, Az Author

yea you really have to laugh at this GERD, what else to do? Poor Nanny, my Dads mom, she just ate peppermints all the time, man they were good, soft sticks in a big round tub wit a red top...hers was glass with a red tin top...she just kept filling it up/but I know now that they did NOT help! man I should have added that to this hub :) love you ethel :)


audib 6 years ago

To RNMSN

I was just diagnosed with Barretts esophagus and I am real confused. I was prescribed Kapidex which I am afraid to take because of the side affects. bradycardia, anxiety, irregular heart beats etc. I have recently had pituitary surgery and diagnosed with acromegaly. I have all these side affects because my pituitary and adrenal system are trying to regulate itself. I started drinking 2 TAB apple cider vengar(regular stoe stuff) in 20 oz glass of warm water with a TAB of honey. Now I go on the barretts site and Kapidex site and it says not to use vinegar. Am I causing more erosion from the acisity. what gives? I don't know who to believe. I have taken prevacid for 20 years shoud i stick with it?Sorry just afraid of the cardiac side affects! Audib


RNMSN profile image

RNMSN 6 years ago from Tucson, Az Author

Dexlansoprazole is used to treat heartburn in people who have gastroesophageal reflux disease (GERD; condition in which backward flow of acid from the stomach causes symptoms such as heartburn, burping, and sour taste). Dexlansoprazole is also used to treat erosive esophagitis [swelling and wearing away of the lining of the esophagus (tube that brings food from the mouth to the stomach) caused by backward flow of acid] and to prevent erosive esophagitis from coming back in people who have already been treated for this condition. Dexlansoprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.

How should this medicine be used?

Dexlansoprazole comes as a delayed-release (long-acting) capsule to take by mouth. It is usually taken once a day. Dexlansoprazole may be taken with or without food, but it may provide more relief from after-meal symptoms if it is taken before a meal. Take dexlansoprazole at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take dexlansoprazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

You should not chew or crush dexlansoprazole capsules. You can swallow the capsules whole, or you can open the capsule, sprinkle the contents on one tablespoon of applesauce, and swallow immediately.

Continue to take dexlansoprazole even if you feel well. Do not stop taking dexlansoprazole without talking to your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking dexlansoprazole,

tell your doctor and pharmacist if you are allergic to dexlansoprazole, or any other medications.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: ampicillin (Principen), anticoagulants ('blood thinners') such as warfarin (Coumadin), atazanavir (Reyataz), clopidogrel (Plavix), digoxin (Lanoxin), iron supplements, and ketoconazole (Nizoral). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor if you have or have ever had liver disease.

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking dexlansoprazole, call your doctor.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Dexlansoprazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

diarrhea

stomach pain

gas

nausea

vomiting

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

rash

hives

itching

difficulty breathing or swallowing

Dexlansoprazole may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

that is all about kapidex and it is still a new and improved proton pump inhibitor...problem is after 20 some odd yrs and still taking it? how is your gallbaldder gone I bet and still taking it? treating the syptoms to avoid causing harm...that is our creed..but the side effect diarrhea? opens up the real can of worms of a bad infection call c difficile...proton pump inhibitors take away all acid good and bad and make us susceptible to losing all the good and bad bacteria in our intestines until only one bacteria is left...c diff...gross stuff

as for not taking your meds silly thing why go to the stupid MD at all if you arent trusting of him? find another MD...get them young smart still questioning everything and still researching everyting they do...younger smarter more high techie MD is the oly way to go hearme?

as fo vinegar its a salt and it will cause over time heart rate problems if you manage to swallow that stuff all the time not only will your esophagus still burn worse your heaart rate will go all wacky... so I am definietly against vinegar its a salt and changes our electrolytes...may as well drink a dozen gatorades a day and ses what happens...or hear second hand if you are lucky what happened from the ER nurse! Oly her lecture will be face to face lol

so in a nutshell

1 find an MD you trust younger smarter better is my opinion...remember I am only a nurse...the physician has the last word but make them back it up with explanations and critical thinking like nurses do....people distrust us and make us defend ourselves but we blithely smile and nod at the MD then double guess them...that's wrong make them prove themselves on the spot ask why!!!

2 take your meds the way the MD prescribed especially important due to pituitary surgery you are playing roulette audib!!!!!!!!!!!!!!!

3 stop the vinegar

4 tell the MD or print this out and show him/her all Ive written

5 much much love to you audb do you love ron l hubbard as much as do? bet you do

love and hope and good thoughts/prayers go to you from me,bb


lambservant profile image

lambservant 5 years ago from Pacific Northwest

RNMSN you remind me a lot of my ex husband. But only in that you are an over fifty male nurse and quite humourous as you explain medical matters. I have Barrett's esophagus and I worry about it all the time. I have found Prilosec to be very effective in the past, but recently it is not helping enough. I have never had much serious pain as far as heartburn goes. But once in a while I wake up at night choking on stuff that has come up and burning my throat. I am afraid I am a coffee addict. It's really bad when I go to AA meetings. They don't have meetings without coffee. You see we have traded one addiction for another, lol. I cannot see a dr. at this time because I am uninsured. But recently my stomach has been acting up more. I have had bronchitis about 6-8 times in the last year because they are saying the stomach acid is affecting my lungs. I have developed chronic bronchitis and I have asthma almost everyday now. Do you think if I quit the coffee that might improve things significantly? Every time I drink it I tell myself "is it worth esophageal cancer someday?" I say "no" and drink up. Thanks for this great Hub RN. And just so you know, although I said you remind me of my ex, his medical expertise, humor, and nursing skills are his greatest assets. The only few he really has. I am sure you are a really nice fellow. God Bless.


lambservant profile image

lambservant 5 years ago from Pacific Northwest

My apolgies RN. I just read your profile and discovered you are a female. There is a man on your profile photo so I naturally assumed you were a male nurse. So, you are a funny, knowledgable, experienced nurse, and thank God you don't look like my Ex. lol. Have a great day/


RNMSN profile image

RNMSN 5 years ago from Tucson, Az Author

hahaha that's my best friend lambservant! that's my David...I am barely to his left/we have been together over 30 yrs/29 of those married :)he is my best friend///

and of course you know you should drop or at least decrease the coffee..and its coffee itself not the caffeine....what we ALL need to do drink more water

ugh I know but there you go nursing lecture of the night!!

love to you barbara b


lambservant profile image

lambservant 5 years ago from Pacific Northwest

I actually love water and drink lots of it. But first thing in the morning, water just doesn't have enough kick. Thanks for the advice.

Lori (lambservant)


RNMSN profile image

RNMSN 5 years ago from Tucson, Az Author

well hello Lori!!! One of my favourite nurses is named Lori :) I love her to pieces

I hate hate hate did I say hate? hate water...it stinks and wont go past my nose

twice I have lived where the water was delicious

on Mr Hargis' homestead 4 room home built in 1902 as a wedding present to his wife (I wrote of him in the one about killing the snake in the house ) and that came out of the spring from the top of the mtn in bisbee az to the house via a garden hose!!!!

and the second was on HWY 2 going to Glacier Natl Park where theres a faucet coming out of the side of a mountain and everybody who knows about that spicket stops and fills up ALL the jugs they have... that water tastes like SNOW SMELLS...the first snoq just after labor day high in the rockies

other than that disney and pepsi can try all they want...nothing beats those two places!

so......I am a BAD nurse :(

I don't drink water.....


Funom Makama 3 profile image

Funom Makama 3 3 years ago from Europe

Wow... This is indeed excellent. Thanks a lot for this share.


RNMSN profile image

RNMSN 3 years ago from Tucson, Az Author

Thank you Funom!


lambservant profile image

lambservant 3 years ago from Pacific Northwest

I had chest pain the day after Christmas this year that was so deep and so severe it woke me up out of a sound sleep. It was not the burning kind of pain. I have chest pain frequently and I chalk it up to anxiety, but this scared the heck out of me. The doctor was concerned that it woke me up. But I had a beautiful EKG, suitable for framing, and clear chest X-ray. Chronic bronchitis continues to plague me. So I am doing the little meals deal, trying to find time in this chronic inclement weather to walk, and I drink water already by the gallons. I know if I lose all this fat it will alleviate this problem for the most part. Quit making coffee at home. But I am really discouraged. I am tired of the bronchitis. Trying to get the dr to refer me back to the specialist. Hope I get better. This is miserable stuff. I worry about cancer all the time.


RNMSN profile image

RNMSN 3 years ago from Tucson, Az Author

I understand about worry! But remember...who is awake and alert and watching over you all the time?And doesn't He get the job of worry? :) I know...easier said/but this is also something I work on all the time too so felt compelled to pass it on :)


lambservant profile image

lambservant 3 years ago from Pacific Northwest

Well thank you RNMSN, I needed that little reminder. God bless.


RNMSN profile image

RNMSN 3 years ago from Tucson, Az Author

Dont we all :) Have a good day!

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