Panitch article #3 ---- 6/21/06

I have been having heartburn off and on for 10 years. I have used Tums,

Rolaids and all of the over the counter medications. Is it time to see a specialist?

All of us have occasional heartburn. This is due to a transient relaxation or weakening of the valve between our esophagus (or gullet) and the stomach. It is normal to have occasional heartburn, especially after large meals, red wine or eating late. One should seek medical advice if this problem occurs more than once or twice a week or if the symptoms awaken one at night with regurgitation, i.e., food in your mouth or a chocking sensation or if the symptoms do not respond immediately to simple measures.

If heartburn persists for over a couple of months, one should seek medical attention because of some inherent dangers of acid reflux or heartburn. Acid reaching the esophagus can cause ulcerations, stricture or narrowing, Barrett’s lining and even cancer of the esophagus. The latter cancer is becoming extremely common and is usually associated with a long history of heartburn and indigestion.

Cancer occurs slowly through a stage called Barrett’s lining. This is the occurrence of stomach lining growing into the esophagus to
”protect the esophagus”. Unfortunately this lining is precancerous in a small percentage of cases and can only be identified by looking at the esophagus with an endoscope and obtaining biopsies. If one has Barrett’s lining, one must have biopsies every one to two years to monitor this condition and pick up early changes of cancer of the esophagus, which can be curable if diagnosed early.

We now have a class of medications called the proton pump inhibitors, i.e., Prilosec, Aciphex, Protonix and Prevacid. These drugs are extremely potent, extremely safe, and can be used for a lifetime without inherent complications. Although Barrett’s lining is not reversible, it can be monitored carefully by a specialist by biopsy and observation every few years. It is important in patients with heartburn and indigestion to know whether they have this precancerous condition or not.

Discuss having an upper endoscopy or EGD with your physician if you experience longstanding heartburn, indigestion, especially if it occurs more than on an occasional occurrence.

Norman M. Panitch, M.D., F.A.C.P.

Diplomate, American Board of Internal Medicine and Gastroenterology

Member, South Bay Independent Physicians Medical Group, Inc.