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HEARTBURN: NO JOKE.

Frequent heartburn can raise the risk of one kind of esophageal cancer, say researchers at the Karolinska Institute in Stockholm. Since the 1970s, the incidence of this deadly disease has increased six-to-eight-fold--more rapidly than any other cancer in the U.S. And middle-aged white men are the likeliest victims.

Jesper Lagergren and colleagues interviewed 189 Swedish patients with adenocarcinoma of the esophagus about symptoms of heartburn they had at least five years before their cancers were diagnosed. For comparison, they also interviewed 820 healthy people and 167 patients with squamous-cell carcinoma of the esophagus, which is less of a mystery and not on the rise. (It's common in poorly nourished people, especially alcoholics, who eat few fruits and vegetables.)

The risk of esophageal adenocarcinoma was a remarkable eight times higher in people who reported heartburn or regurgitation (short of vomiting) or both at least once a week. People who had symptoms at night had 11 times the risk. And those who had symptoms that were more severe and chronic (20 years or more) had an astounding 44 times the risk of those with no symptoms.

That doesn't mean that everyone with heartburn gets esophageal cancer. "Twenty percent of adults have heartburn, ten percent of them get Barrett's esophagus [precancerous changes in the esophagus], and ten percent of them get adenocarcinoma," says Sidney Cohen of Temple University School of Medicine in Philadelphia.

People--including physicians--need to know that heartburn isn't a joke, he adds. "If people have had heartburn for more than five years, if they have it several times a week, if it's severe enough to require a strong medicine like Prevacid or Prilosec, or if it's their main [reason] for going to the doctor, they should have an endoscopy and a biopsy," says Cohen. In that procedure, a physician inserts a scope into the mouth and down the esophagus to examine the cells and take a sample. Taking X-rays of the gastrointestinal tract--a GI series--is useless for finding esophageal cancer, he adds.

Cohen and others think that the cancer starts when stomach acid backs up into the esophagus, damaging its lining. When the lining heals, the new tissue that grows is abnormal.

What about antacids? "People usually take them after they have symptoms, so the esophagus has already been exposed to acid," notes Cohen. The bottom line is that no one knows if antacids help or hurt.

"There are a lot of unanswered questions," says Cohen. "But something has happened in the last 20 years," he adds. "In the late '60s and early '70s, adenocarcinoma of the esophagus was rare."
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Title Annotation:frequent heartburn may increase risk of esophageal cancer
Author:Liebman, Bonnie
Publication:Nutrition Action Healthletter
Date:Jun 1, 1999
Words:430
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