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Hazardous heartburn: reflux disease may cause discomfort and raise your cancer risk, but lifestyle changes and medications can reduce the burn now.

You know the signs of heartburn: the burning sensation radiating from your stomach to your chest and throat, the sour taste in your mouth.

What you may not know is that if you experience these symptoms more than a couple of times a week, you may be feeling the burn of gastroesophageal reflux disease (GERD).

GERD is more than just heartburn. Severe GERD may lead to Barrett's esophagus, changes in the lining of the esophagus that raise your risk of esophageal cancer. And, a study published in the September American Journal of Medicine suggests that GERD may increase your risk of developing cancer of the larynx (voice box).

But, a Cleveland Clinic gastroenterologist says that while GERD shouldn't be taken lightly, reflux patients shouldn't rush out to see their doctor with concerns about cancer. In fact, Edgar Achkar, M.D., says more long-term studies are needed to prove a causal link between GERD and laryngeal cancer.

"I don't think we have the right, despite this study, to tell people with GERD, 'Hey, you have to treat it because if you don't, you'll get cancer of the larynx,'" he said. "Unfortunately, that's the leap of faith that some people take, and I don't think there's enough evidence to make that leap of faith."


GERD occurs when the lower esophageal sphincter, a valve separating the stomach and esophagus, fails to close properly, allowing stomach acid to flow into the esophagus. Being overweight, smoking, alcohol consumption and a hiatal hernia also may contribute to GERD.

Most people with occasional heartburn can find relief simply by taking an over-the-counter antacid and adopting lifestyle changes. (See "What You Can Do" box.)

But, "If you have heartburn more than once in a while that you cannot attribute to a given food and you find yourself having to take an antacid every day, let's say, or if your antacids do not work anymore or you have difficulty swallowing or chest pain, go see the doctor," Dr. Achkar said. taking an over-the-counter antacid


Many GERD patients who seek medical treatment must undergo an endoscopy, in which the gastroenterologist views the esophagus through a tiny camera attached to the end of a tube inserted down the throat. Endoscopy is particularly necessary for male GERD sufferers over age 50 and people who have had GERD for more than 10 years, all of whom are more predisposed to Barrett's esophagus.

Despite concerns about this condition, Dr. Achkar estimated that only about 15 percent of GERD patients will develop Barrett's and only 1 or 2 percent will develop esophageal cancer. "Even though we tell people to be careful of reflux because it can cause Barrett's and Barrett's may cause cancer, if you have heartburn, take care of it, but don't live in fear of esophageal cancer, because only a small number of people develop it," he said.


Two types of medications effectively relieve symptoms in most GERD sufferers:

H2 receptor antagonists (H2 blockers), including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).

Proton pump inhibitors (PPIs), including omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), lansoprazole (Prevacid) and esomeprazole (Nexium).

Unfortunately, medications don't work for everyone, and a few patients may require a surgical procedure known as Nissen fundoplication, in which a surgeon wraps the upper part of the stomach (fundus) around the lower esophageal sphincter to strengthen it. Most of the procedures are done laparoscopically, requiring only small incisions in the abdomen and a 24-hour hospital stay. Fundoplication does not cure reflux--no treatment fully cures GERD--and surgery patients may still have to take medication afterward, Dr. Achkar said.


* Limit your intake of fatty, fried foods, caffeine, chocolate, alcohol and mints--all of which can weaken the lower esophageal sphincter--and citrus fruits and tomato-based products, which contribute to acid flare-ups.

* Do not lie down within three hours after eating.

* Lose weight if you're overweight.
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Title Annotation:Digestive Health
Publication:Men's Health Advisor
Date:Feb 1, 2007
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