That heartburn can be more serious than you think - Cape Cod Healthcare

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Published on April 11, 2016

That heartburn can be more serious than you think

That heartburn can be more serious than you think

Over the years, Robert’s acid reflux intensified. Popping Nexium helped, but his primary care physician – concerned about the potential underlying causes – recommended an endoscopy.

When the results arrived, he learned he was among the one in every 20 acid reflux sufferers who develops Barrett’s Esophagus, a potential precursor to esophageal cancer.

The first question he asked Hyannis gastroenterologist, Jay Yamin, MD., who had performed the biopsy that detected Barrett’s, was straightforward: “Should I be concerned about getting cancer?”

Dr. Yamin’s answer was reassuring.

In this case, the condition was very early in development and showed no signs of “dysplasia,” the enlargement of tissue as abnormal cells proliferate during a potential early stage of cancer.

Still, a second endoscopy was scheduled a year after the initial one. And, despite potential side effects – from osteoporosis to potential kidney damage – a proton pump inhibitor (PPI), was prescribed for daily use.

Some of the more common PPIs are:

  • Omeprazole
  • Esomeprazole
  • Ansoprazole, branded as Prilosec, Prilosec OTC, Nexium, Prevacid and Prevacid 24 hour

PPIs are not some of the more common over-the-counter indigestion drugs like Maalox, Mylanta, Rolaids, Tums, Tagamet, Pepcid or Zantac.

“Even if they are over-the-counter, PPIs should not be taken for more than two weeks without recommendation by a physician,” cautioned Dr. Yamin. “That’s because there are side effects, and a physician should weight the benefits and risks.”

With omnipresent commercials such as Larry the Cable guy promoting the “purple pill,” virtually everyone is aware of acid reflux, which medically is called gastro esophageal reflux disease or GERD.

However, Barrett’s Esophagus is not as well understood.

Your stomach makes strong acid which, along with enzymes, help digest food. But, those with acid reflux have that acid escape from the stomach into the lower esophagus. Often, this is caused by a hiatal hernia, Dr. Yamin explained.

If this reflux goes on for a long time, it can damage the inner lining of the esophagus. This causes squamous cells that normally line the esophagus to be replaced with gland cells, which more resemble those that line the stomach and small intestines and are more resistant to the stomach acid, he added

That’s Barrett’s Esophagus.

In effect, there’s an irony associated with the condition. Your body fights the reflux by morphing cells. But, that morphing is essentially a mutation that can be pre-cancerous.

“Don’t be frightened, but be educated and proactive,” Dr. Yamin told his patient.

Watching your diet and lifestyle, having follow-up endoscopies and taking a PPI a half-hour to an hour before eating in the morning are recommended..

Foods to avoid include:

  • Those foods high in acid, spices or fats
  • Citrus
  • Tomatoes
  • Coffee
  • Alcohol
  • Soda
  • Fried foods
  • Chocolate

Onions – should be eaten in moderation, if not avoided entirely, said Dr. Yamin.

Also, don’t eat within a few hours of going to bed because it is more difficult to digest when lying down, he noted.

The Good News

The good news is that very few people suffering Barrett’s eventually develop cancer.  Dr. Yamin estimates that rate to be half a percent to two percent.

However, for those with high-grade cell dysplasia, the risk is very real that GERD will lead to esophageal cancer.

In these cases, more aggressive intervention is recommended.

“In the past, serious surgery was the protocol,” explained Dr. Yamin. “Today, we try to eradicate Barrett’s with a less invasive process called endoscopic therapy.”

The most common procedure is radiofrequency ablation, which uses radio waves.

Another procedure is cryotherapy, in which the diseased tissue is exposed to extremely cold temperatures and destroyed.

Everyone should be alert to potentially serious effects of acid reflux, especially among those who are overweight, smoke heavily and drink frequently, said Dr. Yamin.

For some people, there may be few if any symptoms of acid reflux. More commonly, you will suffer hoarseness or a sour taste in your mouth. More serious symptoms include:

  • Difficulty or pain with swallowing, a condition called dysphagia
  • Weight loss
  • Fatigue
  • Difficulty or pain with breathing

In those cases, you should consult a doctor, who probably will prescribe an endoscopy.