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When Heartburn Gets Serious.

Esophagus Becomes Damaged, Possibly Pre-Cancerous
By
WebMD Feature

Ignoring heartburn -- just putting up with it, popping a few pills day after day -- isn't necessarily the best plan. There are complications that can result from letting the problem linger.

"When heartburn is not appropriately treated, acid reflux can cause erosion and ulcers in the lining of the esophagus," says William C. Orr, PhD, a clinical professor of medicine and specialist in gastrointestinal disorders at the University of Oklahoma Health Sciences Center.

"It's extremely painful and greatly affects the patient's lifestyle," he tells WebMD. "It really alters very significantly the quality of life."

Long-term acid reflux can cause scarring and narrowing in the esophagus, which can also lead to swallowing difficulties, Radhika Srinivasan, MD, a gastrointestinal specialist and assistant professor of medicine at the University of Pennsylvania in Philadelphia, tells WebMD.

This condition, called esophageal strictures, can interfere with eating and drinking by preventing food and liquid from reaching the stomach. Strictures are treated by dilation, in which an instrument gently stretches the strictures and expands the opening in the esophagus.

In fairly rare cases, chronic acid reflux can also cause a pre-cancerous condition called "Barrett's esophagus," she adds. Barrett's esophagus is a result of the chronic acid reflux into the esophagus (swallowing tube) causing dangerous changes in the cells that line the esophagus -- these cells can become cancerous.

The odds: If 100 people have heartburn on a regular basis for many years, ten would have Barrett's esophagus; one out of those ten would develop esophageal cancer.

Whether you are at risk depends on long you have had symptoms and their frequency, Srinivasansays.

Thus, Barrett's esophagus is not a condition to be taken lightly. The goal of treatment is to prevent further damage by stopping any acid reflux from the stomach. Doctors give patients proton pump inhibitor medications that block acid production like Aciphex, Nexium, Protonix, Prevacid, and Prilosec. If these medications do not limit reflux, surgery to tighten the sphincter, or valve between the esophagus, and stomach may be necessary.

In more severe cases, doctors use a technique called ablation to destroy the abnormal tissue.

If you aren't sure how serious your heartburn is, here are a few tips provided by the doctors at The Cleveland Clinicto help determine if you should see your doctor :

  • Your heartburn symptoms have become more severe or frequent.
  • You are having difficulty swallowing or have pain when swallowing, especially with solid foods or pills.
  • Your heartburn is causing you to vomit.
  • You've experienced a drastic weight loss.
  • You have been using over-the-counter antacid medications for more than two weeks (or for a longer period than recommended on the label), and you still have heartburn symptoms.
  • You have heartburn symptoms even after taking prescription or non-prescription medications.
  • You have severe hoarseness or wheezing.
  • Your discomfort interferes with your lifestyle or daily activities.

If you are concerned, discuss it with your primary doctor who can decide whether you need to see a specialist, Srinivasan says.

And for more about heartburn, visit our guide to Heartburn, created in collaboration with the Cleveland Clinic.

Reviewed on October 22, 2002

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