The Serious Side of Heartburn


Sept. 18, 2006 — -- More than 60 million Americans experience heartburn at least once a month, and more than 15 million experience it daily. While occasional heartburn is normal, chronic heartburn is not and can lead to cancer when not properly treated.

This week "World News" takes a special look at heartburn, with three reports by Dr. Tim Johnson, beginning with tonight's report on diagnosing serious forms of the condition.

Charles Fatone has suffered from heartburn his entire adult life, bringing an unsavory symptom to his palate.

"It's battery acid, absolutely battery acid. I never thought it was serious. I thought it was [from] my bad habits," said Fatone, referring to his tendencies to eat bad foods, eat too fast, and go to sleep right after eating, which he thought was causing the indigestion.

But chronic heartburn is the result of more than bad habits and can happen to anyone.

Heartburn is caused by a leaky valve at the end of the esophagus that allows acid contents from the stomach to back up, or reflux, into the esophagus. The constant exposure to acid can damage its lining.

To examine Fatone's esophagus, doctors gave him an exam in which a lighted scope with a camera on the end was passed down his throat, through his esophagus and into his stomach.

The test results were bad. The doctor discovered Fatone had developed a condition called Barrett's esophagus in which the normal cells that line the esophagus are replaced by cells that are much more likely to develop cancer.

"The problem with Barrett's esophagus is that it is a premalignant condition, meaning that it can lead to esophageal cancer," said Dr. Roshini Rajapaska, a gastroenterologist at New York University Medical Center.

Esophageal cancer is one of the fastest-growing cancers in the United States, and it is extremely deadly if not caught in time. Only 16 percent of patients diagnosed with this cancer will be alive in five years.

Fatone was put on medication to reduce the acid that his stomach produced. Scientists do not know if these medications can prevent the damage done by stomach acid, but they are effective at treating the symptoms of acid reflux.

He will be monitored closely with repeat evaluations of his esophagus. If cancer does develop, it will, ideally, be caught early.

Fatone has classic heartburn. But many people ignore serious acid reflux because instead of heartburn they have other, sometimes confusing symptoms, such as difficulty swallowing, a choking sensation, chronic cough, a sore throat.

For those worried about long-term damage, doctors now have two ways of looking at the esophagus. One is through the kind of test Fatone had. The other is a newer method called the pill cam

A tiny camera is swallowed. As it goes down it sends pictures of the esophagus back to a receiver. Sharon Benzeno, who had two previous endoscopies for chronic heartburn, found the pill cam much easier.

"The pill cam is great. … It is an in and out type of thing," said Benzeno.

The downside of the pill is that biopsies can't be taken if the capture captures something suspicious. But for initial screening or follow-up, it does have the great advantage of avoiding sedation and having a tube stuck down your throat.

If not treated, acid reflux can become very serious -- and even cause cancer.

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