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Bill’s Story: Chronic heartburn may be more dangerous than you think

Heartburn – also called acid reflux – is harmless and just a common digestive condition, right? Yes, it is common but it may not be harmless.

If your heartburn is persistent and symptoms don’t improve with lifestyle changes and medication, it may be time to talk with your doctor about other options. This could be a life-saving decision.

Bill B. has a family history of heartburn. “I had acid reflux for as long as I can recall,” he says, and now he is symptom-free and thankful he took the pro-active steps to treat it.

Bill B. suffered from gastroesophageal reflux disease (GERD,) a serious and common condition where stomach acid rises back up into the esophagus.

While his symptoms included heartburn, a sour burning sensation in the back of his throat and nausea, other common symptoms are: 

  • Upper abdominal pain
  • Difficulty swallowing or the sensation that food is hanging up or not passing down into the stomach properly
  • Regurgitation of food or liquids, particularly when bending over or laying down, associated with a bitter taste in the mouth 

Complications with GERD occur when the valve between the esophagus and the stomach malfunctions, leading to acid, bile and meal contents in the esophagus. This combined reflux of gastric acid and bile leads to severe damage of the lining of the esophagus. The result is that there are changes in the esophagus called Barrett’s esophagus, which can lead to abnormal pre-cancerous cells and esophageal cancer.

Bill B. was diagnosed with Barrett’s esophagus about 10 years ago and was managing his symptoms and Barrett’s esophagus with diet and prescription medicine. Before he had both knee replacement surgeries in early 2014, his doctor recommended he have an upper and lower gastrointestinal (GI) endoscopies done.

“The upper endoscopy and biopsies showed I had additional pre-cancerous cells in my Barrett’s esophagus that was now on the border of being esophageal cancer,” he adds.

Risk of esophageal cancer

“Patients with Barrett’s esophagus have an increased risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus,” explains Atilla Ertan, M.D., Director of the Ertan Digestive Disease Center of Excellence at Memorial Hermann Hospital and professor of medicine at The University of Texas McGovern Medical School.

Approximately 10% to 15% of patients with chronic GERD may have Barrett’s esophagus. “Our multi-disciplinary team of experts are highly trained to treat patients with Barrett’s esophagus and our goal is to prevent progression to esophageal adenocarcinoma,” he notes. “Joint recommendations from gastroenterology societies in the United States encourage patients with Barrett’s esophagus and additional precancerous changes should undergo an upper endoscopy procedure, with extensive biopsies.”

Because of the connection between Barrett’s esophagus and esophageal cancer, “it is crucial that patients with Barrett’s see a gastroenterologist on an integrated basis,” adds Dr. Ertan.

In its early stage, esophageal cancer may not show any symptoms and will only be detected during an upper endoscopy and biopsy. In more advanced stages, these symptoms may occur: 

  • Difficulty swallowing
  • Weight loss, fatigue, weakness, loss of appetite
  • Painful swallowing
  • Pain behind the breast bone
  • Blood in the stool 

Depending on the grade of Barrett’s esophagus, Dr. Ertan and his team perform outpatient endoscopy ablation procedures. “Bill B. is an example of how well these treatments can work to eliminate Barrett’s esophagus, with additional precancerous changes, and prevent the formation of esophageal adenocarcinoma,” he says. “Credit is also given to Bill B. for his own efforts to modify his lifestyle and control his diet.”

“When I learned I was close to developing esophageal cancer, I took immediate action,” Bill B. recalls. “I was referred to Dr. Ertan and I had confidence in him and his staff right away. They are wonderful.”

Bill B. had radiofrequency ablation (RFA) delivered through an endoscope inserted into the esophagus to eliminate Barrett’s and its further precancerous cells. However, after the successful elimination of Barrett’s, his reflux symptoms continued. Recently three endoscopic (endoluminal) antireflux procedures may be helpful to prevent patients ‘ reflux symptoms and minimize precancerous Barrett’s esophagus recurrence. One of these endoscopic (endoluminal) anti-reflux procedures is Stretta, a minimally invasive non-surgical treatment option that is a valuable and safe tool in the management of GERD and possibly minimizes Barrett’s esophagus recurrence.

“The Stretta is an endoscopic outpatient procedure that delivers radiofrequency energy to the muscle layer at the distal esophagus and proximal stomach to improve barrier function and to minimize reflux events. According to multiple clinical studies and our own experience with Stretta, it is effective and has minimal adverse events,” adds Dr. Ertan.

“I was one of the first patients to have the Stretta procedure in Houston,” says Bill B. “After my Barrett’s esophagus with additional precancerous cells were successfully eliminated by the RFA procedure, I had a Stretta procedure by Dr. Ertan. Then I discontinued my long-term reflux medications completely and I have no more reflux symptoms. I am grateful for Dr. Ertan’s expertise, skills and his outstanding team.”

At Memorial Hermann, patients with Barrett’s esophagus receive multidisciplinary care from a team of expert gastroenterologists, pathologists, radiologists, oncologists and surgeons.

“This will not get better on its own”

“I tell people to ask their doctor about their symptoms and learn if they have Barrett’s esophagus,” says Bill B. “There are life-saving options to keep Barrett’s from developing into cancer and my advice is don’t wait too long. This will not get better on its own.”

He is very upbeat and grateful for everything Dr. Ertan and his team have done. Bill B. enjoyed a thriving career in the oil and gas industry for 30+ years before his recent retirement. Even when he had a demanding work schedule he monitored his eating habits. “I was always conscientious about my diet and I continue to be diligent. I don’t eat spicy foods, tomatoes, caffeine, carbonated drinks and I do not overeat or eat too late in the evening.”

He appreciates how supportive his family is. He has been married to his wife for 45 years and they have three grown children.

It is not unusual to spot Bill B. riding around his neighborhood on his bicycle and logging 11 miles a day. Another hobby he enjoys is drilling shallow water wells. He is very happy that he has plenty of stamina to enjoy life.

“I think people would be surprised to know that they can be at risk for esophageal cancer and yet they think they are just battling normal heartburn,” he says.