Correct Diagnosis At Last

twix38 · June 13, 2008

Hello,

I am back in England and as some may remember I had a problem swallowing and have a hiatus Hernia and reflux. I previously left the UK before having time to do more than a Barium Swallow, which showed no problem and after deliberating here, I went to Bumrungrad Hospital where I had a camera down the nose and was told no problem and given medication, which I later looked up on the internet to find was for anxiety. Luckily I had some Omeprazole from my UK doctor and they seemed to help a lot. I stopped taking the anxiety pills the moment I find out what they were for.

Now in UK, I am just back from Southend Hospital (today) where I have my results from Endoscopy and await biopsy from samples taken. as follows.

moderate to severe reflux oesophagitis (grade 3: errosions involving 10 - 50% of the distal oesophagitis-type mucosa). Moderatley inflamed segment of Barrett's mucosa 3cm in length with ulceration. A single ulcer involving the lower oesophagus, 5mm in extent. small sliding hiatus hernia <5cm. Mild raised erosive gastritis involving the prepyloric region. Duodenum was normal.

Diagnosis: Reflux Oesophagitis grade 3, Barrett's Epithelium, Oesophageal Ulceration, Hiatus Hernia, Gastritis

Under comments: Oesophagus and mild gastritis. Suggest treat h pylori if clo positive. suggest logterm PPI if Barrett's confirmed. Small distal oesophageal nodule possibly related to inflammation biopsied.

In discussion, doctor told me that in his opinion it was Barrett's but biopsy needed to confirm. Apparrently he did his degree paper on Barretts. Only a young guy in mid 20's but sooooo much better than my experience at Bumrungrad. Thank you NHS

Well, so much for the bumrungrad, as I even emailed the doctor there afterwards to confirm his findings of no problem. I'd love to sue, as at the least I took false comfort from his all clear and if in any doubt he should have suggested I do more tests as a minimum not parcelled me off in a rush with anxiety pills, whilst not telling me what they were for. I assmed at the time they were specifically to releive/treat my throat symptoms.

I wonder if Sheryl or anyone knowledgable could decipher the above report from the NHS doctor for a layman, comment on severity or otherwise give me further information? I am going to my Doctor in just over a week for biopsy results and am now on Omeprazole (again) as from today. One 20 mg a day and just about to google h pylori if clo positive and PPI if Barrett's confirmed etc.

Edited June 13, 2008 by twix38

Sheryl · June 14, 2008

Glad to hear you've had a proper endoscopy and seem to be in good hands.

H. pylori is a baceria which can cause ulcerations in the GI tract, if the test comes back positive they will put you on a combination of several medications for 2 weeks which should eradicate it.

Barrett's esophagitis is basically having inflamed gastric cells in the lower part of your esophagus, rather than the type of cell normally present in the lining of the esophagus. It is not cancer but can be pre-cancerous i.e. increased risk of cancer of the esophagus later on if Barrett's is confirmed. For this reason, in addition to taking drugs like omeprazole to decrease gastruic acidity, you may be advised to undergo an "ablation" procedure to remove the abnormal cells.

Ask your doctor if you are a candidate for "banding without resection" (BWR), a new approach for ablation which is less invasive and also seems to produce a higher success rate in terms of total eradication of the abnormal cells. . If this is his area of specializiation he will probably know but in case not here is link to a study on it in 2007:

http://www.medscape.com/viewarticle/562444_4

You will also probvably need to have periodic endoscopies (i.e. every year) as a precaution to ensure early detection in case of esophageal cancer. This is quite importnat because by the time esophageal cancers are symptomatic the cure rate is very poor.

The other question is still whether to repair your hiatis hernia. If they do, then ablation of esophagus might be done at same time.

I re-read your old thread to see what the story at Bummers had been . Apparently you saw an ENT who saw nothing in youtr throat and sent you off with a PPI and tranquilizer when what he ought to have done is referred you to a GI specialist for ednoscopy or at least told you to see one if symptoms did not improve. The tranquilizer was of course totally unnecessary and in general what you described of this doctor's approach, sounds slip-shod. He verified that you did not have a problem relevant to his area of specialization and shrugged off.

Now, even if you were in the litigation capital of the world (AKA US of A), you would not have grounds to sue because you have not suffered an adverse consequence thanks to having sought out appropriate care in the UK in time. BUT I do think a letter to the doctor with cc to Custiomer elations and someone in Bumrungrad administration (maybe Tammi can suggest who?) is in order in the hopes of influencing how he treats similiar cases in the future. Do not expect much in the way of an answer and certainly you won't hear back directly from the doctor, but that won't mean he didn't get the feedback and there is a chance it will lead him to be more careful in the future. We all need to learn from out mistakes.

In your letter you need not go into too much detail about what happened at Bummers as they have that on record. Main points should be:

- you went to him (ENT doc) because of trouble swallowing

- he did an ENT exam which showed nothing in the upper throat and sent you home without referral to a GI specialist or instructions to see one if you did not improve

- you have since seen a GI specialist in the UK on your own accord, undergone endoscopy and been found to have Barrett's esophagitis with ulcerations.

- the ENT was negligent in not referring you to a GI specialist or instructing you to make appointment with one if symptoms continued. This caused a significant condition to remain undiagnosed and untreated until you, of your own accord, sought care elsewhere.

Keep it to a half page and as I say, address it to the Doctor with cc to Customer Relations and maybe someone lese at Bumemrs (?ideas Tammi?). At worst you'll waste a small amount of time and at best you may help future patients.

Good luck and keep us posted

You may well

twix38 · June 14, 2008

Thnaks Sheryl,

Very helpfull.

Actually I was on Omeprazole from my UK doctor and not Doctor from Bumrungrad. All he gave me was the all clear and anxiety tablets. I am now on Omeprazole again and wonder about safety and advice if it's 1 pill a day of 20mg for life for me from now? The instructions seem to say for 4 to 8 weeks, though I understand I am going to take one pill a day for life?

I will email Bummers as you advise. I cannot remember the doctors name, so will have to research and await Tammi's details etc in due course here.

How worried should I be at finding I have Barretts? Had this been found well over 6 months ago it would have been better and treated sooner along with the rest of my diagnosed issues. I am appalled at the Bummers doctor's brush off and poor performance as I had taken time to believe I was going to one of the best hospitals where I would get a professional.

BWR. I'll have to enquire if this is on the NHS and wait to see if recomended/available for me subject to my results. Can it be done and recomended anywhere in Thailand? I hoped to return in a couple of months - hopefully not an experience like my only other Thai episode at Bummers? After my only experience in Thailand I will probably delay my return reluctantly, if needed, I guess

Thanks Sheryl for your invaluable help and advice.

Edited June 14, 2008 by twix38

twix38 · June 14, 2008

Additionally Sheryl,

Is your recommended "banding without resection" Ablative technique the same thing as Multipolar Electrocoagulation, as this seemed to be the favoured one in your link, noted as MPEC.

If not the same thing then what is the difference and is BWR a newer one even than MPEC, which was recommended in your link?

btw, I sent an email to Bumrungrad, so will await a reply.

Edited June 14, 2008 by twix38

Sheryl · June 15, 2008

They are not the same. MPEC has been around longer than BWR and the overall complete eradication rate is around 75% as mentioned in the link. BWR in this study -- the first to my knowledge -- showed a success rate of 97%, obviously much higher but should keep in mind that this is just one study. As it was published in 2007 it is them ost current on the topic but there may well be larger scale studies under way to compare it wioth the other techniques.

The other point to consider is that whatever technique is used., it needs to be one that the surgeon is experienced in perfroming and the surgeon obviously needs to be someone you trust and feel comofrtable with. Also, there may be factors specific to your case which would make one technique versus another more appropriate. What you want to do is find a surgeon whoc is as up to date as possible in all of these approraches and get his advice.

As to available in Thailand, could be. Suggest you email several hospitals e.g. Bummers, BNH, BH and Samitivej and specifically ask 1) for names of surgeons experienced in ablation of Barrett's esophagitis and 2) whether the MPEC and BWR techniques for that procedure are currently avalable in their hospital. When you get surgeon names then go to the respetive websites and look up those individual's qualifications.

Unfortunately the problem you experienced is very common. AN underlying flaw is the fragmentation of specialization and attitude of specialists that once they have either terated or excluded a problem relevant to their particular area of sepcialization, their job is completely done and the rest iof the patient is not their responsbility. Wrong attitude, but there it is. There is nobody coordinating or looking over the totality of the patient's care. In days gone by this would have been a GP or Family Medicine specilaist but they are now a vanishing breed. An experienced nurse with broad clinicla experience or a Family Nurse Practitioner could also do it, but you don't find them being used in that capacity in Thai hospitals. In addition I find that for cultural reasons Thai doctors are much less willing to openly seek or give one another advise or to confer on the best teratment for patients with conditions that cross specialty lines.

So what winds up happening is that the patient themseloves has to serve in this function, try to determine which type of specialists are required, and keep tabs on the "big picture". In this respect the NHS, for all the frustration and delays its system imposes, may be far superior.

If you are preared to do the research, be proactive and if you do not have systemic problems that cut across specialty lines, you can obtain top quality sepcialist care in Thailand. But woe to those who don't fit one or both of those conditions. ...as many out there will confirm.

regarding how long you will need to take the PPI (omeprazole) this will be affected by amongh othetr things whether or not you have the hiatus hernia repaired, because that is surely contributing to the GERD. IF you correct it, you will reduce or possibly eliminate the reflux which is the underlying problem and therefore may be able to go off the drug. Should discuss this in detail with your doctor.

As far as how worried about the Barrett's-- I would say don't be worried in the sense of stressed over it, rather take a positive view: 1) you do not have esophageal cancer, which was certainly a possibility given your symptoms and 2) you have found out about the pre-cancerous condition and thus have a chnce to treat it before matters progress to that stage. This is all to the good. At the same time, you should understand that it is a potentially pre-cancerous condition and therefore treatment and careful follow up are in order. In other words, be attentive to the problem and conscientious in attending to it but beyond that do not worry. Stress will only increase your stomach acidity. (seriously - it will).

kin hell · June 15, 2008

Hi , I too was diagnosed with a Hiatus Hernia , reflux Acid , soar throat and swallowing problems when I was back in Europe , then I moved to Thailand and began taking a high dose of

Nexium , to cut a very long story the Nexium eventually stopped working , so I researched my condition here in Thailand after seeing several Thai Doctors and came to the conclusion at that time

the best route was to have a Laproscopic Nissen Fundoplication procedure . I contacted several well known Thai Hospitals about finding some one who was well trained in doing this specialized operation, The outcome of the Laproscopic Nissen Fundoplication procedure depends 100 % on the surgeon having done as many procedures in the past as possible.

The fact was at the time I was searching for a skilled surgeon to carry out this procedure there was no one available in Thailand who was well versed in doing a Laproscopic Nissen Fundoplication procedure , some said they had carried out the procedure while training abroad , as one Doctor told me , not many Thais require the procedure in Thailand. So I eventually

returned to Europe and found a skilled surgeon who's main field was doing Laproscopic Nissen Fundoplication procedures, and had it done around four years ago .

It took about Ten months for the Laproscopic Nissen Fundoplication procedure to fully start working , and now I only take 20 mg Omeprazole a day , and have a Six Monthly endoscope

just to check how things are doing , so far all seems to be Ok.

twix38 · June 15, 2008

Sheryl,

BWR sounds best then, though apart from knowing it stands for Banding without resection I have not found out what it actually is or what is done. Any details??

What is the most common/usual method currently used for ablation, would that be MPEC or I note a study in 2005 mentioned photo-dynamic therapy? Is ablation (another term I don't really understand) the usual standard treatment for Barretts.

When you say "you do not have esophageal cancer, which was certainly a possibility given your symptoms and 2) you have found out about the pre-cancerous condition and thus have a chnce to treat it before matters progress to that stage. "

I certainly hope/expect that I don't have esophageal cancer, but how do you already know I do not, from your statement?

I am awaiting biopsy results and I can't say that I know anything for certain (not being medically aware myself) except that I took time to seek out a professional at a top hospital who was also recommended by a poster here, from memory and I would have been just as well seeing a witch doctor, who may have told me not to be anxious.

I am finally now getting a correct diagnosis and I hope with equally good treatment. As best as I can tell anyway.

thanks so much Sheryl

Edited June 15, 2008 by twix38

Sheryl · June 16, 2008

Sheryl,
BWR sounds best then, though apart from knowing it stands for Banding without resection I have not found out what it actually is or what is done. Any details??

What is the most common/usual method currently used for ablation, would that be MPEC or I note a study in 2005 mentioned photo-dynamic therapy? Is ablation (another term I don't really understand) the usual standard treatment for Barretts.

When you say "you do not have esophageal cancer, which was certainly a possibility given your symptoms and 2) you have found out about the pre-cancerous condition and thus have a chnce to treat it before matters progress to that stage. "

I certainly hope/expect that I don't have esophageal cancer, but how do you already know I do not, from your statement?

I am awaiting biopsy results and I can't say that I know anything for certain (not being medically aware myself) except that I took time to seek out a professional at a top hospital who was also recommended by a poster here, from memory and I would have been just as well seeing a witch doctor, who may have told me not to be anxious.

I am finally now getting a correct diagnosis and I hope with equally good treatment. As best as I can tell anyway.

thanks so much Sheryl

I based the comment on your not having esophageal cancer on your report of the endoscopic findings. Granted, until the biopsy of the nodule is back it is not posssible to be 100% sure, but it does not sound like you do. Certainly you do not have a full blown tumor, that would have been readily appreanet on endoscopy or for that matter on the earlier barium swallow.

Ablation basically means remobval of something, in this case the Barrett mucosa (abnormal cells lining of part of the esophagus). There are many ways of doing that: electric coagulation, lasers etc. MPEC uses the former (also sometimes described as "cauterizing") . In BWR to my understanding the affected segment of the lining of the esophagus is tied off with bands after which the cells will die and slough off on their own.

In all of these techniques, it is done through an endoscopy such as you recently had, only something is done via the endoscope to try to destroy the abnormal cells lining the esophagus. The esophagus itself is not cut, just the cell lining is removed from a segment of it by one technique or another (laser, cauetrey, tying off etc). The idea is that once destroyed the body will replace them with normal cells, however sometimes instead they are replaced with more abnormal cells, which is what the article meant by "recurrence" .

As for is ablation the standard treatment...the symptoms caused by Barrett's can be controlled without it, it is performed because of the risk of a subsequent cancer. I don't know that there are any hard statistics on the percentage of risk of subsequent cancer between people with BE not undergoing ablation and those who do. Would be rather hard to obtain since it would require a control group and raise ethical issues. The science is evolving in this as in everything else, but I believe current thought is that it is best to perfrom ablation even if the symptoms can otherwise be controlled by medication due to the risk of cancer developing, with the exception of the very elderly and persons with some contraindication to the procedure.

All I can say beyond that is that if it were me, I'd want the ablation and by the most reliable technique available i.e. the technique shown to have the lowest rate of recurrence. As far as I can gather this would be BWR or MPEC in that order.

You should have the biopsy report soon and hopefully this will give you a positive definitive answer with respect to the nodule being benign.

Digger · June 16, 2008

The name of the treating doctor is on the receipt when you paid the bill. That's assuming you kept the A4 size bill and receipt from the hospital. if you see one doctor regularly for a continual condition, they will invariably be shown as your treating doctor, but as an infrequent visitor, its the doctor you saw that time. Your HN (hospital number) also allows them to identify who was the treating doctor, HN number and doctor name is on every piece of medication container they give out as well as receipt. I would certainly follow it up - there is some doctor who is head of the doctors side of things - I would copy him/her in as well just so they know what is going on. Personally I would also CC it to the American guy who runs the hospital (at least admin wise) and ensure you mention its a construction comment aimed at helping them improve their health care (not that you really think that, but may stop it ending up in the bin).

twix38 · June 16, 2008

Thanks Sheryl,

I will revert with the biopsy results in due course and go from there. Your help and knowledge have assisted a great deal.

Digger,

I sent an email to Bumrungrad addressed to the doctor who treated me. I tagged it on to an email I had kept from the time, which had all the details and my earlier check about his findings when Sheryl suggested I ask for my patient notes. I await a reply

twix38 · June 17, 2008

I've googled on BWR and banding without resection to try to find hospital(s) - NHS - in UK, ideally South East/London and found nothing.

Does anyone have any idea where this procedure is performed in UK or even Thailand* when I return?

As Sheryl mentioned I would require a well practiced BWR surgeon , but surely the NHS (or even private) do it here?

Thanks

* prefer UK on past experience and language benefits.

Edited June 17, 2008 by twix38

Tolley · June 18, 2008

twix38

I don't know whether you have had any dietary advice but you should be careful what you eat and more especially drink.

You would be advised to not drink beer or soft drinks at all as they will only aggravate your condition.

Things like citrus fruit eg orange juice and foods like chocolate should not be eaten.

You need to try and eat more alkaline foods, things like bananas, avocadoes, almonds, carrots etc

Sheryl · June 18, 2008

I've googled on BWR and banding without resection to try to find hospital(s) - NHS - in UK, ideally South East/London and found nothing.
Does anyone have any idea where this procedure is performed in UK or even Thailand* when I return?

As Sheryl mentioned I would require a well practiced BWR surgeon , but surely the NHS (or even private) do it here?

Thanks

* prefer UK on past experience and language benefits.

What I usually do in cases like this is look for doctors from that country who have published soemthing reklated to the topic and track them down; even if they can't help they may be able to refer you to someone who has.

The following have published on BE (not specifically surgical technicals, but BE and the seem to be surgeons):

Atkinson M and Robertson CS

Department of Surgery, University Hospital, Queen's Medical Centre, Nottingham

M Atkinson seems to now be in the uS but you could see if Dr. Robertson is still at the above hospital.

A University Hospital will be more likely to have the most up to date techniques. Call around to those nearest you, ask for the GI department and then for the names specialists in endoscopic procedures. With a biot of time and patience you'll find someone.

You could also try emailing this doctor in the US and asking if he knows of any hospitals/surgeons in the UK doing ablation procedures for BE:

[email protected]

It's an old email address so not sure if still valid. In it you can say you got it from his 2003 article in "Gastrointestinal endoscopy clinics of North America"

Good luck

twix38 · June 19, 2008

Sheryl and others

What do you think to this website for barretts I have founds on discussion board at http://www.barrettsfoundation.org.uk

Here it is

http://www.barrx.com/

Worthy of serious attention?

EDIT. Just got answer from your contact R. Samplinr as follows

You need to have your esophagitis controlled with proton pump inhibitor prio totherapy. The best ablation now is Barrx radiofrequency. I do not know who doesit in UK but you could contact Hugh Barr.

On the face of it this looks like the one, at least for now, so I will see what further info I can find out.

Edited June 19, 2008 by twix38

Sheryl · June 22, 2008

Twix,

the website is a good find. Note the list of doctors who comprise their medical advisory committee:

http://www.barrettsfoundation.org.uk/healt...ukregistry/sac/

Dr. Barr heads the list and his affiliation is given. But you will probably be fine with any of the physicians on that list or anyone they refer tou to. Good luck.

simon43 · June 22, 2008

Sheryl, totally OT, but your medical knowledge is astounding You should be a doctor....

(that last comment was a joke, just in case you thought otherwise)

I think many of us on TV owe you profuse thanks for your medical advice on this forum

Simon

twix38 · June 27, 2008

Sheryl and others,

Here is my reply from Bumrungrad about telling me all was ok and giving me tablets that I later looked up on the internet to find they were for anxiety and emailed to re-check and ask for my patient notes, for which I received a reply confirming the doctor's results. I actually said Omeprazole did improve and I had stopped taking it a couple of weeks earlier (as it had done the job of clearing my swallowing problem).

"Previous diagnosis and answer was base on the history and examination findings.

I remember that you told me that your barium swallow was normal and omeprazole that not improve your symptom.

If you did not mention about normal barium swallowing, I am confident that I will send you to GI specialist.

In general, the patient need to come back if the symptom is not improved by first medicine.

However I regret to hear your problem."

Does anyone have a contact email address that might get some better level of response as I more than ever feel this doctor has been negligent in his level of professionalism and acceptable treatment with a weak excuse that is part untrue, part poor treatment and part passing the buck. He had to redo the camera down my nose 3 times. Down and out to clean the end and again and again, was in a rush and made me feel at the time like he wanted to get on to his next patient ASAP.

Edited June 27, 2008 by twix38

Sheryl · June 27, 2008

Twix,

While I appreciate your feeling, this reply is actually better than I would have expected -- at least it actually came from the doctor and it is clear he got the message. Naturally he is going to defend himself in some fashion but my reading on this is that he got the message and will undoubtedly be more careful wioth the next patient which was, after all, the whole point of densing the feedback.

This message believe it or not is an apology in doctor-speak.

My advice is leave it be and know that you did a good turn for future patients.

twix38 · June 27, 2008

well it is factually wrong and inept and all.

When I think of the actual experience with 3 attempts because he could not see properly and not even telling me that the pills were for anxiety.

I was dismissed as no medical issue at all and got no answer when asking other than no problem and take these pills.

There was a lot of problem going undiagnosed and had the actual experience been better I may have overlooked the major error of medical professionlism, but you are probably right.

I will leave it there, happy to have helped the next guy, I hope.

I have been totally put off Thai Hospitals or treatment.

Thanls for your help Sheryl and I get my biopsy results next week. I'll let you know some intersting info on trials etc then too. Thanks again

Edited June 27, 2008 by twix38

twix38 · June 27, 2008

Bit more time now to reply thoughtfully.

I am in 2 minds about it.

On the one hand I am content the doctor has replied and apologised in Doctor speak and I have helped future patients. That's enough

On the other hand I am annoyed I traveled to Bangkok to see a specialist where I thought I would get the best treatment and paid for it.

I had an unimpresive consultation feeling rushed and with 3 attempts to clean the camera after putting it down my nose 3 times.

The incorrect fact in his statement that I had said Omeprazole did not help. It did and I told him it had.

The Barium swallow cannot cover the scope of an endoscopy or show detail, so it doesn't excuse not telling me to seek further treatment if symptoms returned/didn't get better and neither does it explain the "all clear" statement he gave me and the anxiety prescription and not telling me what it was for, as I assumed it would clear the blockage until I looked it up on the internet. This clearly hinted at his real diagnosis of (there is a word/expression for it, meaning lump or blockage that is not really there but is felt). I am quite clear he didn't do his job properly because of his assumed diagnosis on finding nothing. It's that obvious because he made assumptions that were wrong and didn't treat or advise me properly either. How much worse could an inspection be than to leave a bad impression at the time and get it all wrong without advising me anything other than all ok, nothing wrong, take these pills to help.

I'm always happy to help others, but I am simply not satisfied with this doctor. However, I have done all I can and am currently just annoyed at the whole episode from start to finnish, as anyone would be and venting a bit. Hopefully i'll feel happier next week when I have my biopsy results, some 9 months after I saw this Bumrungrad Doctor and having only arrived back in the UK 2 weeks ago and getting my NHS endoscopy performed 2 days after my Doctor's visit, where my problems were quickly and efficiently found. They were not hiding if you looked properly and thoroughly.

We all talk about things from personal experience and I will never recommend getting health or medical attention in Thailand because on top of this personal experience there is also no accountability or recourse if things go wrong. It's just tough luck, if you are unlucky. Maybe I will be forced into a good experience in the future by circumstances, but until then i'll rely on good old England and not make the mistake of thinking I can keep to my schedule and get it done in Thailand. Just my opinion.

I can say the nurses are good at smiling, weighing and blood pressure checks, but for me it stops there if a place like the Bumrungrad delivers the above.

Edited June 27, 2008 by twix38

Sheryl · June 28, 2008

Twix, I like the place even less than you do, and have a collection of grievances (on my own and other people's behalf) that spans decades. And definitely it has gotten worse lately in terms of rushed outpatient consultations. I have the impression that the management is timing how long each doc spends with each patient and setting limits/targets (which would be perfectly in keeping with their overall inability to discern that there might be an essential difference between running a hospital and a hotel). That said, I still sometimes go there/ bring others there (gritting my teeth as I pass through the valet parking and ostentatious lobby) if it happens that the best specialist for what is needed works there.

If it's any comfort, due to the routing of the email he will have had to answer to his administrative bosses.

And I strongly suspecvt that the next time he sees a patient with trouble swallowing and a negative ENT exam, barium swallow or no, he will refer to a GI specialist.

twix38 · June 28, 2008

Thanks Sheryl,

I assume you work in BKK (Thailand) as you sound a bit jaded and I for one don't want to live in Thailand all year round. A big holiday during the English Winter is good though.

It's been a case of " if I knew then what I know now".

I will revert with my results and with some usefull info in due course and my thanks to you and other helpfull posters.

My recommendation. Get yourself treated in your home country, for many reasons including language, culture and not to mention treatment and accountability. It's a whole lot better.

twix38 · July 1, 2008

I decided to press Bumrungrad a little more as I was dissapointed on so many levels and to correct an error in the reply. I received this email reply today from their Coordination Physician, International Operations.

Your email addressed to Dr. Khemchart Tonsakulrungruang was forwarded to our office for assistance. Please allow me to introduce ourselves.

The medical support team consists of doctors and nurses with a role to communicate to Bumrungrad’s foreign national patients who may have concerns or suggestions regarding their care at BI, investigate any concerns and respond back accordingly. We also provide the same support to our staff as well.

We understand your concerns, which you have articulated well in your e-mail below, relate to the medical care provided by Dr. Khemchart Tonsakulrungruang and regret that this consultation did not meet your expectations. We are very happy to hear that you are receiving continuing care in England for your condition.

We would like to thank you for taking the time to communicate your concerns and would like to assure you all comments we receive are reviewed very carefully to ensure that our hospital maintains its globally renowned high standard of medical and service quality. We will be reviewing these concerns with our process detailed below:

A review of the clinical records and any other relevant information in your record.

A request to the attending physician(s) or any other involved staff to review the specific matter and advise us of their opinion.

A conclusion is made to address the specific issue and this is communicated back to you.

Our process may take up to 30 business days, at which time if you wish, the conclusion of our investigation will be communicated back to you. However, if our investigation is complete before that time, or if there are any delays due to our need to have a more in-depth investigation, obtain further opinion or if the physicians (or other involved staff) are unavailable for some reason, we would keep you informed.

Again, we regret that you are unhappy with the care you have received here at Bumrungrad International.

Edited July 1, 2008 by twix38

twix38 · July 7, 2008

Sheryl et al,

Finally had my diagnosis, I assume for Barrett's and nodule.

Glandular mucosa showing moderate chronic inflammatory infiltration. No Goblet cell. Area of low grade dysplasia is seen

Gastric mucosa showing moderate chronic inflamatory infiltration. No metaplasia or neoplasia is seen. H Pylori are not seen.

I am on 40mg of Omeprazole daily and awaiting details of next stage which I assume will be another endoscopy after 2 to 3 months to re-check, biopsy and ensure ulcer has healed.

If I were to have ablation, I would choose Barrx Radiofrequency, though I am told not to bother to undergo ablation with low grade dysplasia, but I should find out if my nodule is in my barrets or not, and if it is, I should consider removal of nodule by EMR

Anyone any comments?

I await to hear from Bumrungrad regarding my earlier post.

Here is some general info and discussion groups.

http://www.barrettsinfo.com/content/3c_what_is_dysplasia.htm

http://www.barrettsfoundation.org.uk/

http://www.barrettsfoundation.org.uk/forum/

http://www.barrx.com/

http://www.barrx.com/Patients_and_Families/index.cfm/42

http://www.barrettsadvice.com/?p=28

http://www.barrettsadvice.com/forum/viewfo...54480cd741b2b5a

http://pathology.jhu.edu/beweb_chat/

Barrx: Synmed website