Early monitoring, treatment can reverse damage before it turns deadly
An occasional bout of indigestion or heartburn is generally nothing to worry about. But there is growing concern about the dangers of frequent or chronic heartburn.
Often presenting as GERD or gastroesophageal reflux disease, it can cause sleep problems, chronic cough and even asthma. But worse than that, it can put you at higher risk for Barrett’s esophagus and esophageal adenocarcinoma – an aggressive, potentially fatal cancer of the esophagus.
Unfortunately, this type of esophageal cancer has jumped six-fold in the past 20 years – faster than any other malignant cancer in the United States. The reason for the sudden upsurge is unclear, but studies show that most, if not all cases, are preceded by damage in the lower esophagus caused by GERD.
About 10-15 percent of people with GERD develop the precancerous condition called Barrett's esophagus. Those with the most benign forms of Barrett's have a 5-8 percent lifetime risk of developing esophageal cancer; the more advanced forms pose a higher risk.
Until more is known about the reasons for this rise in esophageal cancer, doctors say more aggressive monitoring and treatment of GERD patients is needed.
"If you’re having heartburn more than once a week, and especially if you’re having complications, such as difficulty swallowing, it’s time to consult a physician and develop a treatment plan,” said Scott Corbett, MD, a gastroenterologist at Sarasota Memorial Hospital and one of the nation’s leading physicians studying and treating patients with precancerous conditions caused by GERD.
"Barrett's is a protective mechanism gone bad," Corbett said. "Barrett cells are actually more tolerant of acid, and when they form on a person’s esophagus, their symptoms will often improve, giving a false sense of security. But it is the genetic changes in these cells that allowed them to form that ultimately predispose a person to cancer."
In one of the largest studies published in the world, Corbett and other gastroenterologists demonstrated the importance of early treatment of Barrett's with radiofrequency ablation, a minimally invasive therapy that uses energy to burn off precancerous cells lining the esophagus.
The study included 429 patients treated by gastroenterologists at four community hospitals. The hospitals in Chicago, Atlanta and Nashville pooled their results with those from Sarasota Memorial, revealing that the therapy can successfully treat precancerous spots in over 90 percent of patients. The outcomes were similar or better than those achieved in smaller studies previously conducted only at academic institutions or teaching hospitals, Corbett said.
If patients keep their acid under control during the healing process, Corbett said the body will replace precancerous Barrett cells with normal esophageal cells, in effect turning back the clock and giving a second chance to those at risk.
While it's not yet certain that this method will block cancer from ever forming, the studies are promising enough that specialists have begun debating how to better reach at-risk patients who suffer from Barrett's esophagus. Currently, Barrett's sufferers have had to submit to frequent, lifelong endoscopic screening to check for the stages immediately before cancer, or to see if early cancer is present. Then, removal of the esophagus may be recommended. Experts have criticized this strategy as unreliable, anxiety provoking, and not cost effective.
“We know that if patients have reflux, but do not have Barrett's, and if we keep their symptoms under good control with acid suppressive medication, they are very unlikely to develop Barrett's,” Corbett said. "Our ongoing studies will hopefully prove that these patients are not going to get esophageal cancer."
Date Published: May 17, 2009
Media Contact: Kim Savage
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