DEAR DRS. DONOHUE AND ROACH: I have been diagnosed with GERD and Barrett’s esophagus. My doctor put me on 20 milligrams of omeprazole once daily, and it seemed to work well. I read about the bone problems with omeprazole and stopped taking it because I also take phenytoin (Dilantin), and I have a balance problem: My fear is that I could fall and break a bone.

I started using aloe extract. I take it twice daily, and it works great. I have had no problems with my GERD since I started taking the aloe. I told my doctor about this, and he did not seem too happy with me for stopping the omeprazole. I would appreciate your opinion about this problem. — R.G.

ANSWER: GERD, gastroesophageal reflux disease, is a condition in which stomach acid goes up into the esophagus, the muscular tube that carries food from the mouth to the stomach. Acid doesn’t belong in the esophagus, so it can cause sensations of burning, or can bring about a cough in some people. Many people have no symptoms.

A few people, after years of acid going up into the esophagus, will develop Barrett’s esophagus — the lining of the esophagus starts to look like stomach lining. This puts the esophagus at higher risk of developing adenocarcinoma, a type of cancer. Researchers believe, but haven’t proven, that reducing the acid in the esophagus can prevent cancer. Studies have proven that the abnormal lining of the esophagus can start to return to normal with high doses of medicines like omeprazole, so it makes sense that omeprazole can prevent cancer in those cases.

Unfortunately, stopping symptoms doesn’t always mean that the lining is returning to normal. Even though the aloe may be helping your symptoms, there is no guarantee that it is helping to stop the Barrett’s esophagus and protect you against esophageal cancer. I suspect that is why your physician seemed unhappy.

You are quite right that both phenytoin and omeprazole can affect the bones and make them more likely to fracture. But I would recommend asking your physician to test your bones for fracture risk before you stop these medicines, since they are both doing very important jobs.

DEAR DRS. DONOHUE AND ROACH: Can you please address Moyamoya disease? My husband’s cousin was recently diagnosed with it following a stroke and is undergoing surgery. We heard that there may be a genetic component to the disease through the mother. Is this true? What are the cousin’s chances for a full recovery? — K.O’C.

ANSWER: Moyamoya disease, despite its odd-sounding name (Japanese for “puff of smoke”), is a serious disease involving blockages of the major blood vessels in the base of the brain, called the circle of Willis. It is most prevalent in Japan but is rarely found in this country. Only about 10 percent of Moyamoya is familial, and the genetics are not related to gender, even though the condition is a bit more common in women. Surgical treatment for this condition is designed to increase blood flow to the affected part of the brain. In expert hands, the results can be very good. This is one of the conditions for which it pays to consult with the person with the greatest experience you can find.

READERS: The booklet on stroke explains a condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Donohue — No. 902, 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.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.

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