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The Honolulu Advertiser
Posted on: Sunday, May 19, 2002

PRESCRIPTIONS
Untreated heartburn can jeopardize long-term health

By Landis Lum

If you're among the many people who suffer from heartburn, you should know that it's more than a mere nuisance. Untreated, it can lead to long-term health problems.

Heartburn affects 40 percent of Americans once a month, and 7 percent every day.

Five percent of sufferers will develop ulcers of the esophagus, or food tube, and 10 percent of those with untreated heartburn will develop a stricture, which is a persistent narrowing of the food tube caused by scarring from acid damage. Stretching procedures or surgery may be required to restore normal swallowing.

More ominously, 6 percent of people with significant heartburn (also known as gastro-esophageal reflux disease, or GERD) have unrecognized pre-cancerous changes in their lower food tube, a condition called Barrett's esophagus.

People with Barrett's have 30 to 125 times the risk of developing cancer, and 1 to 2 percent of them will develop cancer each year. At highest risk are those who develop GERD at an early age, and in whom symptoms last longer than average, occur at night or are more severe.

For a doctor to detect Barrett's, you are given a sedative through your vein, and an endoscope — a thin, flexible plastic tube containing a tiny camera — is inserted down your throat. This does not interfere with breathing.

Many experts recommend endoscopy in anyone with heartburn more than five years, or a one-time endoscopy at age 50 in people with persistent GERD.

However, there are certain cases where endoscopy should be done immediately: when a person reports pain with swallowing, trouble swallowing, weight loss, anemia or bleeding.

How do you know if you have GERD? It usually causes a burning pain in the middle of your chest, which can become worse when you're lying down. Patients often report an acid, sour or bitter taste. GERD can cause asthma, chronic cough, morning hoarseness or chest pain.

What can you do about it? Lose weight, sleep with the head of the bed elevated with blocks by about 4 to 6 inches, and avoid things that impair the functioning of the valve between the stomach and esophagus — namely, smoking, caffeine, coffee (even decaffeinated), chocolate, alcohol, mints and carbonated drinks.

Also, avoid tight clothing, particularly around the abdomen. Avoid anti-inflammatory drugs such as aspirin, ibuprofen (Motrin and Advil are common brands) or naproxen (Aleve), among others. Tylenol (acetaminophen), however, is OK.

To find relief from GERD, you can try over-the-counter pills, such as Pepcid, Tagamet or Zantac. Add antacids like Mylanta II or Riopan Plus II if pain persists.

If your heartburn still troubles you, you may need to see your physician for even more powerful medications.

Research suggests that bile as well as acid plays a role in the development of cancer in Barrett's esophagus. Prilosec, Protonix, and other so-called proton pump inhibitors suppress acid and bile, and so, in theory, should reduce cancer, though this has yet to be demonstrated.

Another option that reduces reflux of bile and acid, and has a 90 percent rate for curing heartburn, is a surgery called fundoplication, in which the top part of the stomach is wrapped around the food tube to strengthen the valve. This can be done laparoscopically, with several small incisions rather than one large incision.

However, Dr. Peter Kahrilas of Northwestern University reported in the January 2001 issue of the journal Seminars in Gastrointestinal Disease that when it comes to fundoplication surgery, the risk of a complication or death outweighed that of long-term treatment with proton pump inhibitor drugs, making drugs preferable to surgery. However, if drugs don't work, surgery may be a good option.

If you're more than 100 pounds overweight or more than twice what should be your normal weight, the best strategy may be to get gastric bypass weight loss surgery, which is the only thing that works to lose lots of weight permanently. It also cures heartburn, and also can be done laparoscopically.

Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine. Write: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column provides opinions and information, and is not intended to provide medical advice; you should consult your doctor.