DEAR DR. DONOHUE: For many years, I had heartburn, and I lived with it by taking things like Tums. Finally, I consulted a doctor, who referred me to a gastroenterologist because he was alarmed at the length of time I’d had it. The gastroenterologist gave me a scope exam of my esophagus and stomach. It turns out I have GERD and something called Barrett’s esophagus, which turns into cancer. Naturally, I am nervous. I’ve never heard of heartburn-caused cancer. How often does that happen? — A.S.

ANSWER: Not often, but enough that plans have to be made to keep checking for such a change.

Heartburn is officially called GERD, gastroesophageal reflux disease. Stomach acid squirts upward (refluxes) into the swallowing tube, the esophagus. The esophagus isn’t built to deal with stomach acid, the way the stomach is. The result is heartburn.

Medicines for GERD are many. The ones most often chosen are proton pump inhibitors, medicines that all but turn off acid production. Their names are Prevacid (lansoprazole), Dexilant (dexlansoparazole), Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole) and Aciphex (rabepraxole).

Up to 12 percent of GERD patients, even with treatment, develop Barrett’s esophagus. The lining cells of the lower part of the esophagus change into ones that are more resistant to stomach acid. That change can evolve into another transformation that is precancerous. That’s called dysplasia. Dysplasia can then become cancer. The absolute risk for this is small, but it is real, and has to be carefully looked for.

If the Barrett’s cells show signs of low-grade dysplasia, then a follow-up scope exam of the esophagus is done in six to 12 months and repeated annually. If high-grade changes are found, the scope exam is repeated every six months. If no dysplasia changes are seen, follow-up exams are scheduled for every three years.

The booklet on hiatal hernia and GERD gives a comprehensive treatment on this subject. Readers can obtain a copy by writing: Dr. Donohue — No. 501, 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 really should not be writing to you. I have enjoyed quite good health for more than 80 years, and I am grateful for that.

I am still active sexually without having to use things like Viagra. Friends tell me that sex at my age is asking for sudden death. Is that for real? I see a doctor regularly, and he says I am in good shape. — R.B.

ANSWER: Continue as you have been. The demand on the heart from sex is the equivalent of walking up two flights of stairs. Age is not a contraindication.

Most people who have had a heart attack are not told to abstain from sex. You don’t need to either.

DEAR DR. DONOHUE: I have been put on Synthroid for an underactive thyroid gland. I looked in my book of medicines, and it says that Synthroid should be taken by older people only “under close supervision.” Exactly what does “close supervision” mean? I didn’t get any special instructions. — M.B.

ANSWER: Synthroid is thyroid hormone. If you’re not making enough of it, you need the hormone in pill form.

Thyroid hormone keeps all body processes working at their best speed. A sudden speed-up of body chemistry and other physiological processes might be hard on an older person’s heart. For that reason, the hormone usually is prescribed in smaller doses for older people until the person’s body gets used to it. Smaller doses are actually more effective in older people than they are in younger ones. That’s the only supervision you need.

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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