DEAR DR. DONOHUE: I have heartburn, and I can control it with medicine and by watching what I eat. My doctor wants me to have a scope exam of my esophagus because, he says, heartburn can turn into cancer. Can you explain this? It’s news to me. – H.B.

Heartburn has the official name of GERD – gastroesophageal reflux disease. Stomach acid and digestive juices are squirting up into the esophagus. The esophagus is the long, tubular passage that food takes to reach the stomach. Just before it joins the stomach, it has a muscle – a sphincter (SFINK-tur) – that encircles the lower esophagus. The sphincter keeps it closed to prevent the backsplash of stomach juices.

People with GERD have a sphincter that has gone on vacation. Stomach juices in the esophagus cause the pain of heartburn. Some people with heartburn – but definitely not all – experience a change in the lining cells of the lower esophagus. That is a Barrett’s esophagus, and a small number who have these changes go on to develop cancer of the esophagus.

There are no symptoms that alert heartburn patients that they have Barrett’s esophagus. The diagnosis is made through a scope inspection of the esophagus and a biopsy of the lining tissue in its lowermost section.

People who have Barrett’s esophagus need follow-up scope exams to detect cancer changes. Esophageal cancer is a particularly troublesome cancer.

Today’s medicines combined with a few minor diet changes can usually control heartburn. If Barrett’s disease complicates heartburn and if the cell changes appear to be on the verge of becoming cancer, there are treatments for eliminating the suspicious cells. One treatment can be done with the scope, a special medicine and a laser.

Heartburn and hiatal hernia are some of mankind’s most prevalent disorders. The pamphlet on those topics goes a long way in explaining them and their treatment. To order a copy, write to: Dr. Donohue – No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Can you help? I have hives that won’t stop. They have come every day for the past two months. I have tried many skin salves, but none works. What can I do? – V.R.

You have chronic urticaria. It’s a daily or almost-daily outbreak of hives for six or more weeks.

The search for a cause must be made. Finding a cause and eliminating it eliminates the hives. An allergist or a dermatologist can start the investigation for you. That is the most important step you can take.

Up until quite recently, many people with chronic hives could not find a cause. Now there are a substantial number of hive patients who fit into a newly described category where antibody production is responsible. The antibodies these people make land on cells and cause them to release histamine. Histamine is the substance that brings on hives and itching.

One way to test for these antibodies is to take a tiny amount of the patient’s blood, let it clot, and then inject into the skin a minute amount of the serum that forms above the clot. If it brings out a hive, there is evidence that the person’s hives are ones caused by antibodies that he or she makes.

Antihistamines are good for this type of hive, as they are for all other types.

In resistant cases, where antihistamines are not bringing relief and where antibodies are shown to have a hand in the outbreak, a quite powerful medicine, cyclosporine, can help patients turn the corner in their war with hives.

DEAR DR. DONOHUE: Are electric blankets safe? I use one, but I’ll turn it off if you say it could be harmful. – F.E.

Electric blankets generate heat and electromagnetic waves. There are people who insist that those waves are a threat to health. I don’t subscribe to that.

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.

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