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Ignoring acid reflux symptoms can lead to bigger problems

SARASOTA

Comedy legend Dick Smothers loves Florida. He has lived in Sarasota for nine years and along with Tommy, his "mom-always-liked-you-best'' older brother, just retired from concert touring this year. Now Dickie, as he is still known by friends and fans, has devoted himself to a healthy retirement.

"I've made myself my best hobby," said Smothers, 71.

He starts most days with a wheat grass shooter and organic whole grain cereal, then a ride on one of his bicycles (he has one for each day of the week). Then it's off to Pilates and weight training. Lunch is usually a vegan creation laced with flaxseed oil. The rest of the day may find him practicing yoga, kayaking, putting in time on his home treadmill or just reading. Right now he's enjoying Deepak Chopra's The Third Jesus.

"I'm addicted to physical fitness and health," he said Monday over the phone.

His voice sounded hoarse and raspy, a problem he said had been getting worse for the past few years. He finally decided to find out what was wrong.

A trip to the gastroenterologist revealed Smothers has a condition called Barrett's esophagus, a change in the organ's lining that can lead to cancer. It's a rare cancer, but it has its roots in a condition well known to millions of Americans: acid reflux.

Properly known as gastroesophageal reflux disease, or GERD, acid reflux occurs when the stomach contents (food or liquid) leak back from the stomach into the esophagus. Stress, overeating, alcohol and many other factors can bring it on.

Smothers remembers having acid reflux as far back as the late 1960s while working on the hit TV show, The Smothers Brothers Comedy Hour. "We'd go across the street for lunch and have martinis and Rolaids," he said.

According to the National Cancer Institute, about 10 percent of patients with persistent GERD develop Barrett's esophagus. What happens is that acid splashing back damages the lining of the esophagus and the body tries to heal itself by making new, acid-resistant tissue.

Over time, and for reasons not fully understood, the new tissue goes through a genetic change. A tiny fraction of Barrett's patients — less than 1 percent — develop throat cancer, but it's a highly lethal form of the disease, according to the National Institutes of Health.

"It's not a true cancer at first, just a change in the cells," said Dr. H. Worth Boyce, professor of medicine and director of the esophageal and swallowing disorder center at the University of South Florida.

"But you need to be watched and rechecked, because a small number of patients will develop cancer in the top layer of cells."

At highest risk are overweight white males, age 50 and older, with a history of reflux. But as Smothers' case shows, you can be physically fit and develop the problem, too.

"There's a 99.5 percent chance of not developing cancer, but there is a risk. If you are followed and treated early, there's an excellent long-term outlook," Boyce said.

Treatment for Barrett's includes avoiding fatty foods, alcohol, caffeine and tobacco, and losing weight. Medications like Pepcid, Zantac and Nexium that reduce stomach acid production can also help. Certain endoscopic medical procedures can kill or surgically remove the abnormal cells.

More recently doctors have begun using radiofrequency ablation, or RFA, to burn off the potentially cancerous cells.

That's the procedure that Smothers had on Tuesday at Sarasota Memorial Hospital.

His physician, Sarasota gastroenterologist Dr. Scott Corbett, has performed RFA on more than 100 Barrett's patients over 4 1/2 years using a device called the Halo 360, made by Barrx Medical. Corbett was part of a large, multicenter study to confirm RFA's benefits for Barrett's patients.

"Although we haven't proven that we have prevented cancer, we intuitively understand that we should have already had many more patients go on to develop cancer and we aren't seeing that happen," Corbett said of the overall study.

Locally, Halo is also available at Tampa General Hospital and H. Lee Moffitt Cancer Center.

Boyce has seen the studies and is impressed with the results. "It appears to be, at this time, pretty effective and safe," he said.

The challenge is deciding who needs treatment, and who will do fine with lifestyle changes and medication. Doctors have no way of knowing which Barrett's patients will develop cancer. Corbett lets patients guide him. "It depends on the stage of their disease, their family history, their age, their overall health and their anxiety level," said Corbett.

Smothers was monitored for more than two years before Corbett recommended treatment. The decision was easy for a man who takes his health very seriously. In fact, he says it was not him but his brother Tommy, who now runs his own winery in California, who tired of the constant travel their touring act required.

"It's not going to give me 50 more years of abuse," Dickie Smothers said of his struggle with Barrett's.

Now that he and his doctors have resolved the issue, he says of his life: "I'm going to treat it like it's a golden gift."

Irene Maher can reached at imaher@sptimes.com.

Acid reflux

Tempting as it is to pop a pill or take a swig of antacid when heartburn strikes, if the problem is persistent (two or more days a week), see your doctor for a more permanent solution — which for many people can mean lifestyle changes, such as losing weight. Untreated heartburn can lead to:

Barrett's esophagus

Bronchospasm (irritation and spasm of the airways due to acid)

Chronic cough or hoarseness

Dental problems

Esophageal ulcers

Inflammation of the esophagus

Stricture (a narrowing of the esophagus due to scarring from the inflammation)

Source: MayoClinic.com

Ignoring acid reflux symptoms can lead to bigger problems 10/06/10 [Last modified: Wednesday, October 13, 2010 2:19pm]

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