Does heartburn lead to cancer?

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DEAR DR. DONOHUE: I was diagnosed a year ago with Barrett’s esophagus with no dysplasia. I tried taking a generic version of Nexium, but it did not help at all. A second doctor advised me not to take drugs, since they didn’t help. I tried more than one. I do plan to get regular endoscopies. I have been living in fear for the past year. Is Barrett’s a death sentence for me? Am I at great risk for cancer of the esophagus? — L.R.

ANSWER: In some people, the eruption of stomach acid into the esophagus — heartburn or, more formally, GERD, gastroesophageal reflux disease — transforms lining cells in the lower part of the esophagus into cells that resemble cells that line the colon. That is Barrett’s esophagus.

About 10 million Americans suffer from GERD. Around 1 million of these people eventually will develop the changes of Barrett’s. People with Barrett’s are at greater risk of developing esophageal cancer, but the risk is small. However small the chance, all stops are pulled out to detect cancer changes. That is accomplished by following your doctor’s schedule for scope exams of the esophagus.

“Dysplasia” indicates changes that are progressing to cancer. You have no dysplasia, and that’s a great plus for you.

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Standard treatment of Barrett’s is taking medicine that greatly decreases production of stomach acid. Drugs called proton pump inhibitors are the most powerful suppressors of stomach acid. Nexium is one of those drugs. Even with treatment, cancer is not always prevented. Surveillance with scope exams is necessary for all with these changes.

Barrett’s isn’t a death sentence for you, even if you cannot tolerate medicine treatment. Other medicines can ease the symptoms of heartburn, medicines unrelated to proton pump inhibitors. Zantac is an example. Whether they influence the development of cancer hasn’t been proven.

DEAR DR. DONOHUE: Several years ago, I read that dark beer prevents colon cancer. Since then, I’ve been drinking Guinness, one of the darkest I know of. I drink two bottles a week. Recently I read an article that said any type of beer could cause many types of cancer. Is there any truth to either? — J.M.

ANSWER: Sources I trust don’t endorse beer as a preventive against colon cancer. They say that having more than two beers a day for men and one for women heightens the risk of colon cancer somewhat. Two beers a week isn’t a threat.

The booklet on colon cancer describes this common cancer and its treatments. Readers can order a copy by writing: Dr. Donohue — No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a 65-year-old male who has experienced anxiety and panic attacks most of my life. I take Paxil daily for it. Most of the time, I do not have attacks. In times of crisis, traveling, etc., they rear their ugly head. My wife and I are retired and would love to travel, but even the thought of traveling brings them on. Are there any new medicines or treatments? — Anon.

ANSWER: Panic attacks are periods when a person is overwhelmed with dread of something that poses no real threat. Breathing and heartbeat speed up. Sweat breaks out. The person trembles and feels death is on the doorstep. Partly, the attacks are biologically caused. Some deficiency in the production of brain messenger chemicals makes a person vulnerable to them. You could try a medicine different from Paxil, or you could add a medicine that calms anxiety. Xanax and Klonopin are examples. You use them in anticipation of an attack. You’d be wise to seek counseling with a therapist. Cognitive behavior therapy aims to teach you how to recognize the lack of threat in situations that you perceive as provoking panic. Such treatment isn’t long term.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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