Complications from heartburn on the rise
Updated: 2008-04-01 08:09
WASHINGTON -- Chronic heartburn is a daily acid bath for the esophagus, and complications from it are on the rise. New government figures show a worrisome increase in esophagus disorders from severe acid reflux. The worst one, esophageal cancer, is continuing its march as the nation's fastest-growing malignancy.
What to do if you're one of the estimated 3 million Americans whose eroded esophagus means high risk for this especially deadly cancer? More doctors are trying to zap away the worst damage, beaming radiofrequency energy down the throat to burn off precancerous cells.
While it's not yet certain that will block cancer from ever forming, the studies are promising enough that specialists have begun debating how to better find at-risk patients, people who suffer a condition called Barrett's esophagus. Ironically, a damaged esophagus may no longer feel the burn of acid reflux, keeping sufferers in the dark.
"You become desensitized. You can go a long time without knowing you have Barrett's," warns Dr. John I. Allen of the American Gastroenterological Association.
Heartburn sometimes is a temporary problem, but it also can signal gastrointestinal reflux disease, or GERD, where a loose valve allows stomach acid to regularly back up into the delicate esophagus. Millions have GERD, which is on the rise along with expanding waistlines. For most people, acid-suppressing medications are the answer.
But severe reflux over many years can cause serious problems for a fraction of people. The lining of the esophagus erodes until it bleeds, narrows to make swallowing difficult or, worse, starts to repair itself with more acid-resistant intestinal cells that happen to be more cancer-prone. That last condition is called Barrett's esophagus, and sufferers are 30 times more likely than the average person to go on to develop esophageal cancer.
Hospitalizations for all reflux-caused esophageal disorders doubled between 1998 and 2005, says a sobering new count by the U.S. Agency for Healthcare Research and Quality.
And over the past two decades, esophageal cancer has risen six-fold. About 16,470 Americans will be diagnosed with it this year, according to the American Cancer Society. Fewer than one in five survives five years, and 14,280 are predicted to die this year.
Hence a renewed focus on Barrett's patients, to try to prevent their damage from progressing to cancer.
The good news is that esophageal cancer is slow to develop, so Barrett's patients are given regular down-the-throat exams to spot precancerous changes in cells. Those termed "high-grade dysplasia" are the most dangerous — one in five of those patients will get full-blown cancer within five years.
Cutting out the esophagus has long been standard treatment to stop high-grade dysplasia from turning into cancer. Don't go straight to that extreme step, say guidelines issued last week by the American College of Gastroenterology.
Instead, the new guidelines urge a two-step process: Send a device down the throat to carefully slice off the precancerous layer and make sure it hasn't already turned into invasive cancer. Then burn away the remaining Barrett's tissue with other endoscopic techniques in hopes of getting healthy cells to grow back in its place — as long as patients stay on long-term, acid-controlling drugs, too.
There are various ways to burn away the problem areas, but specialists increasingly are turning to a device named Barrx that lets them nestle a balloon directly onto the esophagus lining and beam RF energy straight into it.
Small studies suggest Barrx can successfully treat precancerous spots in about 90 percent of patients with no return in two years and counting. Specialists are anxiously awaiting a more in-depth study, to be released later this spring, that compared 120 patients who got either Barrx or a sham procedure.
"It'll have very impressive results," promises Dr. Richard Sampliner of the University of Arizona Health Sciences Center, one of the 19 participating medical centers.
A big question, though, is whether precancerous cells still lurk under the new healthy cells that form, ready to grow again. So patients getting Barrx or other ablation treatments today can't yet abandon regular endoscopic exams.
"Common sense suggests if we eliminate the Barrett's segment, we're going to eliminate the cancer in people. That really will take decades to know for certain," cautions Dr. John Carroll of Georgetown University Hospital.
But Carroll is optimistic enough that this spring, Georgetown begins a study to see if it's worth doing Barrx treatment even earlier — in patients whose Barrett's esophagus hasn't yet developed precancerous spots.
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