heartburn

Sometimes Benign, Sometimes Not!

By Omar Khokhar, MD, OSF Medical Group, College Avenue Gastroenterology

eartburnalso known as gastroesophageal reflux disease (GERD)is a burning sensation just behind the sternum or in the upper abdomen. The pain may radiate to the neck, throat, or jaw. Nearly one in 10 Americans experience symptoms of heartburn once a week. In most cases, heartburn symptoms are not serious, and are generally controlled by avoiding triggers, such as certain foods, medications, obesity, and stress. Attention should be paid to so-called alarm symptoms, such as chest pain, coughing, difficult or painful swallowing, weight loss, vomiting, black stool, and stomach pain. The presence of these symptoms may represent other conditions such as cardiac disease, esophageal spasm, esophageal motility disorder, ulcer disease, cancer, and Barretts esophagus. What is Barretts esophagus? Barrett's esophagus occurs as a result of chronic reflux of stomach acid into the esophagus (the tube that carries food from mouth to stomach). This exposure to stomach acid can result in a change in the lower lining of the esophagus, known as the mucosa. If the mucosa changes to a state known as intestinal metaplasia (IM), there is a higher chance of esophageal cancer. Recent data shows at least one in every 250 individuals with IM will progress to esophageal cancer. How is Barretts diagnosed? The physician uses a device called an endoscope to examine the esophagus and remove a small amount of tissue for biopsy. The tissue is then examined under a microscope to confirm the presence of IM. Barrett's esophagus can be further classified with low grade or high grade dysplasia, each of which confers a higher risk of progression to cancer. Does everyone with heartburn get Barretts esophagus? No. Conversely, not all patients with Barretts esophagus have heartburn. Risk factors for development of Barretts esophagus in patients with heartburn symptoms are: Age 50 or older Male Presence of heartburn more than five years Obesity Presence of a hiatal hernia Central fat stores Individuals with any of these risk factors should consider being screened by having an upper endoscopy. Is Barretts permanent? Not necessarily. Some studies have shown a reduction of Barretts with the use of medications such as Prilosec, Nexium, Protonix, Aciphex, Dexilant, or Prevacid. For patients with long-standing Barretts, family history of esophageal cancer, or Barretts with dysplasia, ablation therapy of the mucosa can be considered.

What is ablation therapy? Ablation is a technique where tissue is heated until it is no longer alive. Various forms of ablation have been used for nearly a century to treat a number of cancerous and precancerous conditions. The HALO ablation technology is a very specific type of ablation, in which heat energy is delivered in a precise and highly-controlled manner. Ablation therapy for Barretts is performed in conjunction with upper endoscopy and is performed in an outpatient setting. Long-term data (more than five years) has shown HALO to be safe, effective, and durable. HALO ablation, however, does not eliminate the need for surveillance endoscopy at defined intervals. For more information, or to find help identifying a possible underlying cause for your heartburn, please call OSF Medical Group College Avenue Gastroenterology at 309-665-4040 or visit www.osfmedicalgroup.org.

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April 2013 Bloomington Healthy Cells Magazine Page 39