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When antacids aren't enough

That chronic heartburn could be a sign of something more serious. Doctors are seeing more cases of rare but deadly esophageal cancer.

April 10, 2006|Shari Roan | Times Staff Writer

Doctors disagree on how to best treat Barrett's esophagus. Many recommend continued use of acid blockers and proton pump inhibitors, which cut acid production, along with regular endoscopy and biopsy to monitor the cells so that if cancer occurs it's caught as early as possible. Some experimental data also suggest that regular aspirin use may help prevent this type of cancer.

"We just don't know what's best," says Dr. Brian Reid, an expert on Barrett's esophagus at the University of Washington's Fred Hutchinson Cancer Research Center. "This is why patients are between a rock and a hard spot."

Abnormal tissue can be removed surgically. And doctors are beginning to use several new technologies to remove the abnormal Barrett's tissue from the esophagus through an endoscope.

One method, called photodynamic therapy, uses a chemical that is injected into a vein and then activated by a laser light, destroying the tissue.

Another method, called thermal ablation, uses heat to destroy the tissue. Ablation is becoming more popular but lacks long-term studies to show its effectiveness.

Lyday, who uses a newer ablation device called the Halo 360, says: "My feeling is if you should be followed for the rest of your life, why not remove it? It's logical and it's low risk."

DeVault says he recommends ablation only if the cells point to a precancerous condition.

"We would not advocate ablating Barrett's without the risk of cancer because the majority of these patients are going to live their life out without having cancer," he says.

Health experts agree on one point: People with long-term GERD should see a doctor, even if the symptoms seem under control or have disappeared. In the last 10 years, several heartburn medications have moved from prescription to over-the-counter status -- including the 2003 approval of Prilosec for frequent heartburn -- which may mean more people self-treat.

"If you have heartburn every once in a while, it's nothing to worry about," says DeVault. "But if you keep a bottle of antacid on your desk and take them all day long -- those are the people who need to see their doctor."

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