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Letter to National Institute of Health

Posted Jul 24 2011 1:35pm

To the National Institute of Health If you recall I have documented over 20 cases of esophageal specialized intestinal metaplasaia that have shown normalization with absence of metaplastic histology on surveillance endoscopy. These results were obtained as the result of treating patients with GERD to SUPPRESSION OF NON-ESOPHAGEAL symptoms. "Quieting" the amplified autonomic response to GERD with successful therapy results in remarkable outcomes. Vagal stimulation is clearly involved whether aspiration happens or not is usually irrelevant (the aspiration vs autonomic/vagal debate)., The first step in improved quality of life is realizing that GERD may be the generator of diverse symptoms/signs/problems. Once the dx of atypical GERD is entertained, followup with the conviction that attention to details and titration/escalation of therapy OFTEN is rewarded with dramatic resolution of issues that are sometimes unanticipated!

Last week I spoke at the local community center, "The Many Faces of GERD" was the title of the presentation and over 100 preregistered were in attendance.

In the question period, most all questions dealt with extra-esophageal problems like cough, throat clearing, non-cardiac chest pain, adult onset asthma, chronic sinus problems, etc. According to testimonials, on the infrequent occasion these symptoms were felt to be associated with reflux, the treatment was sub-therapeutic having been exposed to various agents in ordinary doses. If history repeats, 10-20% of those in attendance will end up in my office and my best estimate is 80% of those will ultimately have have significant symptom resolution.

I spoke in June to the Michigan Sleep Alliance. As a result a 3 month old was brought to me suffering with "failure to thrive, poor sleep {always <2 hr duration}, constant nasal mucus, sneezing spells, aggression based crying and frequent (2 -3 times a week?)Dr visits.

I suggested life style changes and started the infant on ranitidine suspension for GERD. I saw the child this week for follow up and ALL symptoms markedly improved or gone, no Dr. visits and a 2# weight gain in the 4 1/2 weeks since therapy institued. Mom reports after the 1st dose the infant slept 4 hours. The next day with 3 daily doses the child slept 8 hours as she continues to nightly.

We need to educate the provider population and alert them to the frequent occurrence of non-esophageal GERD symptoms. I am here to testify that dosage titration of anti-secretory medications rather than an arbitrary twice daily fixed dose can frequently alleviate symptom burden. I too have found individuals that fail to respond to the therapeutic strategy but I find many more that do respond with individualized, titrated "high dose" treatment and attention to lifestyle changes and the addition of barrier antacids.

If what I claim is true, then a study with the end point of symptom suppression in atypical GERD by titration of anti secretory therapy would be revealing and likely trans formative in establishing a new paradigm. A properly designed study would almost certainly be terminated prematurely because it would be inappropriate to with hold treatment in the control group.

I personally feel it unethical to NOT TREAT these patients by ignoring their symptoms (as many have been when they finally find me). How can such favorable outcomes be disseminated? How can our medical community be allowed to remain ignorant of this epidemic/pandemic and these truths? This is not confined to our community since I receive requests for guidance/insight/help from people all over the USA and occasionally other countries. Anything going on in the NIH in this regard?

Thank you for listening

Kurt A Barrett DO

PS I write letters, publish articles when I can, speak anytime a group will have me, respond to phone calls and maintain a web site with altruistic motives with the intent of EDUCATION.

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