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April 28, 2017 What men 50 and older should know about the heartburn, cancer connection
Article Pages -- as published on the The Kalona News website.

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ARTICLE DESCRIPTION:

(BPT) - CBS Pittsburgh’s senior weather anchor, Jon Burnett, has spent over three decades forecasting storms, and knows all too well in some cases there is a calm before a storm — some hit without warning. This is his health journey.

What started off as his usual annual endoscopy routine took a turn — one he’d thought about but didn’t see coming as he sat dumbfounded while his doctor uttered the words "You have Barrett’s esophagus." Barrett’s esophagus is a primary risk factor for esophageal adenocarcinoma (EAC), a type of esophageal cancer.1-5 It is part of a progressive sequence that usually starts as chronic heartburn, also referred to as gastroesophageal reflux disease (GERD), progresses to Barrett’s esophagus, and ultimately to EAC.

Not only had Jon lost his maternal grandfather and paternal uncle to EAC, but 10 years ago his mother underwent a surgical procedure to help reduce the likelihood of developing the disease as well. Knowing the severity of this disease, as well as his increased risk because of his family history, Jon started having an annual endoscopy to monitor his digestive tract. However, he didn’t expect the Barrett’s esophagus diagnosis that day. “I had no heartburn or discomfort associated with acid reflux — I’d just downed a glass of orange juice. I was in good health, at least that’s how I felt,” said Jon.

Jon’s primary care physician prescribed him proton pump inhibitors (PPIs) to reduce stomach acidity, which was the mainstay treatment then. PPIs are one of the most widely used types of medications for patients with GERD, but some experts have grown concerned that they are being overused.6 PPI use has been associated with osteoporosis and bone fracture, hypomagnesaemia, the development of gastric polyps, enteric infections, interstitial nephritis and pneumonia.6 “After 10 years on PPIs, I wanted another treatment option that posed less health risks, so I consulted with Dr. Blair Jobe, a GI specialist, to find out my other treatment options,” said Jon.

Dr. Jobe, Director of the Esophageal and Lung Institute at Allegheny Health Network, conducted several tests before confirming Jon’s Barrett’s esophagus diagnosis. “I recall Dr. Jobe reassuring my wife and me that he was going to do everything possible to prevent this from turning into cancer. As we discussed my treatment options, I learned about radiofrequency ablation (RFA), an outpatient procedure that uses heat to remove the pre-cancerous cells lining the esophagus,” said Jon.7 “I had the procedure in October 2016, and was thrilled to hear that it was successful. I feel great and lucky to be alive! My family gave me a beautiful gift — because of their struggles and our family history, I was screened, diagnosed and sought proper treatment before my Barrett’s esophagus progressed to EAC,” said Jon.

Barrett’s esophagus is a pre-cancerous condition characterized by a change in the lining of the esophagus. It is generally asymptomatic, and as a result can be hard to detect; more than 90% of esophageal cancer patients were never diagnosed with Barrett’s esophagus.8 EAC is the most rapidly rising cancer in the US and has a low survival rate.1,9 Approximately 82% of people diagnosed with EAC will die within 5 years of diagnosis.9 Caucasian ethnicity, male sex, old age, smoking, obesity, chronic heartburn, family history of Barrett’s esophagus or EAC and length of Barrett are the most common risk factors for progression of Barrett’s esophagus to EAC.5,10

People can reduce their progression risk through a proper treatment.8,7,11 Diagnostic tools such as reflux testing provide the doctor and patient with a more accurate GERD diagnosis and can lead to early treatment and possibly better outcomes for patients.12 Studies show RFA has over a 90% likelihood of treating precancerous tissue from the esophagus of Barrett’s esophagus patients before it becomes cancerous.7-8,11

When should men 50 and older with chronic GERD talk to their doctors?

If you have a family history of Barrett’s esophagus or EACIf you are experiencing chronic heartburn or GERDIf you have already been diagnosed with GERD, but have not discussed Barrett’s esophagus

For information about GERD, Barrett’s esophagus and EAC or to find a specialist in your area, visit refluxprogression.com.

References:

1 Pohl H, Welch G et al. The role of over diagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005;97:142-6.

2 Vaezi M, Zehrai A, Yuksel E, Testing for refractory gastroesophageal reflux disease, ASGE Leading Edge, 2012 Vol 2, No 2, 1-13, American Society Gastroenterology Endoscopy, Page 1.

3 De Jonge PJ et al. Risk of malignant progression in patients with Barrett’s oesophagus: a Dutch nationwide cohort study. Gut. 2010;59:1030-1036.

4 Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut 2012 Jul;61(7):970-6.

5 Spechler et al. Barrett’s Esophagus. N Engl J Med 2014; 371:836-45.

6 Nimish V, Prescribing Proton Pump Inhibitors Is it Tme to Pause and Rethink? Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI. Drugs 2012 (4) 437-445, Page 437.

7 Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency Ablation in Barrett’s Esophagus with Dysplasia. New England Journal of Medicine 2009 May; 360(22):2277-2288.

8 Dymedex Market Development Consulting, Strategic Market Assessment, Barrx, October 30, 2014. References 1, 3-5, 7-13, 15, 16, 20-23, 25, 27-29, 40-44, 46, 48-50, 54-59, 62-66, 68-71, 76,78, 80- 83, 87-89, 97 and 100 from the full citation list, access at http://www.medtronic.com/giclaims.

9 SEER Cancer Statistics Factsheets: Esophageal Cancer. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/esoph.html.

10 Evans JA et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointestinal Endoscopy. 2012;27(6):1087-1094.

11 Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12)1209-17. doi:10.1001/jama.2014.2511.

12 Gawron A. & Pandolfino J. Ambulatory reflux monitoring in GERD – Which test should be performed and should therapy be stopped? Published online: 9 March 2013.

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