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 radio-frequency 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.
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, according to a sobering new count by the U.S. Agency for Healthcare Research and Quality.
And over the past two decades, esophageal cancer has risen sixfold. 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.
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.
New guidelines, however, urge a less radical 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 to replace the tissue – as long as patients stay on long-term, acid-controlling drugs, too.
