When heartburn turns serious

(Conclusion)

Monitoring and treatment. Doctors usually recommend that patients with Barrett’s be monitored with upper GI endoscopy and biopsies. Studies are underway to develop tests that will help pathologists and physicians better determine which Barrett’s patients are likely to go on to develop cancer and which will not. The bottom line is that although you have an increased risk of cancer and should always seek medical treatment for heartburn that occurs at least once per week, there is no need for immediate panic. Even if you do have Barrett’s monitoring is usually effective. Closer monitoring is called for in cases in which low-grade dysplasia is diagnosed.

In cases of high-grade dysplasia, surgery is generally necessary. Esophagectomy, removal of the esophagus, is typically reserved for patients who have high-grade dysplasia or cancer and is not recommended for patients who have Barrett’s esophagus alone. It is important to recognize that frequent heartburn is a disease, not just a lifestyle inconvenience. So don’t ignore it. When you seek medical attention for your heartburn, you will, at a minimum, improve your quality of life and may very likely help your doctor recommend further screening to prevent progression of the disease. Doctors can prescribe antacids, H2 blockers, or proton-pump inhibitors for healing lessons. There is no cure, but with these treatments and some simple lifestyle changes, you can keep your symptoms in check.

In addition, some people with severe GERD have significant regurgitation that doesn’t respond to lifestyle changes and common medication treatments. In this cases or when the cost and inconvenience of lifelong medication is not wanted, anti-reflux surgery, e.g., a "Nissen wrap, can be performed. In this procedure, the surgeon tighten the area around the lower esophageal sphincter muscle, which protects against reflux. This procedure provides a long-term solution to GERD in the majority of patients, but about one-third will require medication again later on. Hospital stay time is minimal for this procedure.

Controlling your symptoms through lifestyle changes. Although lifestyle changes rarely provide a complete cure for chronic heartburn there are things that you can do to control your symptoms. They include wearing loose clothing, eating smaller meals, avoiding lying down for three hours after a meal, losing weight and avoiding fried or fatty foods, citrus fruits, tomatoes, chocolate, coffee, carbonated drinks and alcoholic beverages. Also, elevating the head of your bed can assist in reducing symptoms. Smoking can cause the LES to weaken, so it’s important to quit.

When to seek treatment. There are no set guidelines as to when heartburn deserves treatment. They think the key is the chronicity of the heartburn. Heartburn more than three times per week for longer that one year in someone over the age of 40 concerns. Any person with heartburn and trouble or pain on swallowing should seek an evaluation. Other ‘alarm’ signs also include anemia and weight loss. Specific symptoms for GERD that should generate a physician visit include weight loss, poor appetite, vomiting, difficulty swallowing and persistent weakness, suggesting possible anemia. Other symptoms such as hoarseness, wheezing and chronic cough also should be attended to be a physician and may reflect underlying GERD.

Stay tuned for new Barrett’s and cancer therapies. Some interesting new therapies are now available for heartburn and Barrett’s esophagus. Two such therapies, the endo-CinchTM and the StrettaTM procedure, are endoscopic procedures that involve tightening the area around the LES to block the reflux. Although interest is keen for both because they are less invasive than other therapies, more long-term studies are need to establish their safety and efficacy. A new therapy under investigation is ablation therapy for Barrett’s esophagus in which the Barrett’s lining is destroyed. Much about heartburn and its consequences still needs to be learned, but with each new study, our knowledge advances. Heartburn symptoms can be controlled and managed. The bottom line is that chronic heartburn should never be ignored. Seek medical attention to control your symptoms and improve your quality of life, and you may even head off more serious complications.