Barrett's: More than acid reflux

Medicine

April 08, 2005|By Mary Beth Regan | Mary Beth Regan,SPECIAL TO THE SUN

When local writer Jonathon Scott Fuqua lost a close friend to esophageal cancer in 2001, he dealt with his pain by penning a young-adult novel about a boy grappling with his father's imminent death from throat cancer.

The book, The Willoughby Spit Wonder, was published in 2004 to rave reviews - only months before Fuqua found out that he, too, suffered from a throat ailment that was a precursor to the cancer that claimed his friend's life.

As The Willoughby Spit Wonder hit bookstores, Fuqua was diagnosed with Barrett's Esophagus, a rare but preventable throat disease that can progress to cancer. In recent months, the writer has turned his attention to talking about Barrett's disease, in part because it is so easily treated if caught early.

"There's a lack of understanding about Barrett's," says Fuqua, 39, who lives with his wife and two children in Baltimore's Mayfield neighborhood. "You can easily treat conditions that cause Barrett's. But once you get the disease, there's no reversing it."

Barrett's Esophagus is linked to gastroesophageal reflux disease - GERD - which millions of Americans mistake for heartburn or indigestion. Roughly 60 million adults experience heartburn once a month, according to the National Institutes of Health, and 25 million people suffer daily.

About 15 million of these people will develop full-blown GERD, a throat inflammation that can lead to ulcers, erosive esophagitis and Barrett's disease, according to The Doctor's Guide to Gastrointestinal Health, a new book by Dr. Paul Miskovitz, of the Weill Medical College of Cornell University.

Of those 15 million GERD patients, about 500,000 will progress to Barrett's, an ailment marked by changes in the cellular lining of the throat. Between 5 percent and 10 percent of Barrett's patients progress to the often fatal esophageal cancer, Miskovitz says.

"The numbers aren't huge," Miskovitz explains, "but it's huge if you're that one guy."

Dr. Marcia Canto, director of endoscopy at Johns Hopkins Medicine, says, "A lot of people have suffered silently with GERD, and then they present with full-blown cancer.

"You can't just treat yourself with bottles of Tums," Canto adds. "If you have a history of indigestion that is significant, you need to bring it to the attention of your physician."

In September, Fuqua underwent an operation to treat his Barrett's. He's still grappling with the odd turn of events.

In 2001, his friend Tim Nelson died. The next year, the writer began his book, which was published in 2004 in Nelson's memory. Months later, Fuqua received his Barrett's diagnosis.

"It's so befuddling," says Fuqua, a marathon runner with a youthful, rugged look. "It's just a funny thing. ... Sometimes it seems like a cruel joke."

Equally disturbing to Fuqua is the lack of information available about how to treat conditions that cause Barrett's.

He traces his own illness to 1993 when he experienced acid reflux for the first time. Acid reflux occurs when acid from the stomach backs up into the esophagus.

"After awhile it was happening every day," he says, "so I started treating it with over-the-counter medicines. Whatever was cheapest."

Like many patients with acid reflux, Fuqua mentioned it to his doctor. He had an endoscopy, a procedure to examine the esophagus, and was found to have an irritated esophagus. He was put on prescription medication to control stomach acid.

Many doctors say Tums or Maalox are fine for occasional indigestion because they neutralize acid in the esophagus. But if symptoms persist, doctors recommend stronger medications.

One approach is acid suppression therapy, which blocks the body's histamine production, a chemical that stimulates acid secretion. Medicines that accomplish this include Pepcid AC and Tagamet HB.

Also prescribed are proton pump inhibitors - PPIs - that block acid production by shutting down a stomach mechanism called the proton pump. These drugs include Prilosec and Nexium.

Fuqua was on such drugs for years. In 2002, he had a second endoscopy. His esophagus still was irritated, but he was able to switch back to over-the-counter medication.

Two years later, his doctor ordered a third endoscopy. "I didn't give it 10 minutes of thought," Fuqua says. "A friend dropped me off. I could have cared less."

But when he awoke from the procedure, Fuqua received startling news. "I remember the doctor saying, `Well, I know what your problem is. You have Barrett's disease,' " he says.

Doctors aren't certain how an irritated esophagus progresses to Barrett's disease.

At some point, the delicate esophageal lining, which is not designed to withstand repeated acid exposure, changes in cellular structure to more closely resemble the stomach or small intestines. Often, those with Barrett's have patches of cellular changes throughout the esophagus. These cells rarely return to normal.

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