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GERD: A Growing Concern

Gastroesophageal reflux disease afflicts 25 million U.S. adults

SUNDAY, Nov. 24, 2002 (HealthDayNews) -- Gastroesophageal reflux disease, or GERD, is a chronic condition that is more common than you might think but missed more often than you might guess.

Yet, GERD's symptoms are all too familiar to the 25 million American adults who experience them on a daily basis: heartburn; an acid taste in your mouth; trouble swallowing; and regurgitation of food.

Most mild cases are easily treated with changes in eating habits and medications, and more severe ones can be treated with the latest in surgical procedures. But some doctors are starting to make the troubling link between the increasing number of GERD cases and a similar jump in the number of cases of esophageal cancer.

GERD occurs when stomach acid makes its way into the esophagus, usually because the valve that separates the two relaxes as people age. Alcohol, chocolate, caffeine and heavy meals can aggravate the condition.

"For most people, GERD is a lifestyle issue," says Dr. Garth Ballantine, a New Jersey surgeon who treats those with serious GERD. "If you're like me and have steak and red wine for dinner and maybe a cigar and glass of port afterwards, well, anyone who has that meal is going to have reflux. And I can choose not to have reflux by avoiding those foods."

However, those whose symptoms are more constant and more severe need to get treatment before more serious conditions develop.

That's part of the reason why the fourth annual GERD Awareness Week starts today, supported by the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

"GERD, of which heartburn is the most common symptom, is pretty common among adults," says Dr. Timothy Wang, head of gastroenterology at the University of Massachusetts School of Medicine. "And the major concern is that esophageal cancer is the fastest-rising cancer in the United States -- up 8 percent a year -- and a presumption is that the rise is related to GERD."

"But while there is a lot of research on GERD, there aren't a lot of answers," Wang adds. "So we are treating GERD more aggressively, but don't want to over-alarm people, as those at risk for cancer are a pretty small group, only about 1 percent."

That group includes those with a condition called Barrett's esophagus, which occurs when chronic GERD has changed the cellular makeup of the lining of the esophagus, Wang says. When that happens, those people face a higher risk of esophageal cancer.

Esophageal cancer strikes men three times more often than women, according to the American Cancer Society. It's not a common cancer -- roughly 13,100 new esophageal cancer cases will be diagnosed in 2002, according to estimates. That compares to 131,600 new cases of colon cancer.

Although people with Barrett's esophagus need to be monitored regularly, Wang says, the majority of people with GERD can turn to simpler treatments to control their discomfort.

"The usual numbers are that 40 percent of the adult population get heartburn once a month, 7 percent once a week and 3 percent once a day. And 98 percent of these symptoms are controlled by lifestyle changes or over-the-counter medicines," Ballantine says.

To relieve symptoms, people can take antacids, which eases heartburn by neutralizing the acid in the esophagus. For chronic reflux, he says, doctors prescribe stronger medicines, including Pepcid and Tagamet, and proton pump inhibitors such as Prilosec.

For approximately 2 percent of people, however, medication doesn't help. Doctors then have to check for a hiatal hernia -- when part of the stomach moves up into the chest. They can also assess the acid levels in the esophagus and look at the lining of the esophagus through a small camera, a procedure called an endoscopy, Wang says.

The procedure can find inflammation, ulcers or the cellular changes in the esophageal lining that signal Barrett's esophagus, Wang says, "but most peoples' esophageal linings look normal."

If doctors do find that chronic GERD is too uncomfortable or dangerous to a person's health, there are some surgical procedures that can tighten the valve that controls the amount of acid that leaks into the esophagus.

The U.S. Food and Drug Administration (FDA) recently approved two minimally invasive surgeries for GERD that can be done on an outpatient basis. One procedure uses a tube with a tiny device on the end that can stitch and tighten the valve, and the other uses a catheter with needle electrodes that use radio waves to tighten the valve. However, Ballantine and Wang say early results on both of these procedures are mixed.

As a last resort, Ballantine says, patients can have laparoscopic surgery that can correct a hiatal hernia or tighten the stomach around the bottom of the esophagus.

Better yet, he says, you can stop GERD before it leads to problems.

"Most people can choose among certain lifestyle changes that will or will not prompt reflux," he says.

What To Do

A thorough description of GERD can be found at the National Digestive Diseases Information Clearinghouse or the International Foundation for Functional Gastrointestinal Disorders.

The IFFGD also maintains a Heartburn Helpline (888-964-2001) for additional information on GERD.

Information about esophageal cancer can be found at The National Cancer Institute.

SOURCES: Timothy Wang, M.D., chief, gastroenterology, University of Massachusetts School of Medicine, Worcester, Mass.; Garth Ballantine, M.D., director, department of minimally invasive surgery, Hackensack University Medical Center, N.J.
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