Fire in the Belly

By Michael Lemonick

It usually starts an hour after I eat: a burning sensation that hovers somewhere behind my breastbone. If I have an antacid on hand, the burning subsides. If not, it builds until I'm in fiery agony. I still remember one awful night 25 years ago, when I ate a greasy lump of fried dough on a train in Yugoslavia. It felt as though I had swallowed a vial of hydrochloric acid. Actually, that's not too far from the truth. The stomach is essentially a bag filled with powerful acid. If it weren't for a lining of protective cells, the stomach itself would dissolve. If the acid stays put, most people never give it another thought. Sometimes, though, it doesn't stay put. Foods like chocolate, mints, caffeine and alcohol relax the esophageal sphincter--a ring of muscle that guards the entrance to the stomach--letting acid bubble up to burn the unprotected esophagus. Smoking and fatty foods like my Yugoslav doughball can send acid levels soaring.

Most of us call the resulting pain heartburn (though it has nothing to do with the heart). If you get it often, it's called gastroesophageal reflux disease, or GERD. Along with an estimated 15 million Americans, that's what I've had for nearly 30 years. No big deal, though--or so I thought until I read a paper in the New England Journal of Medicine a couple of weeks ago. Turns out that this repeated acid bath can alter esophageal cells, creating a condition known as Barrett's esophagus. Once that happens, the cells can become precancerous, then malignant. For someone like me, with almost daily heartburn, the overall risk of esophageal cancer--one of the nastiest cancers--is a horrifying 43 times greater than average.

And so I found myself last week in the examining room of Dr. Robert Meirowitz. Like many of his fellow gastroenterologists, Meirowitz has seen an upswing in patients since the journal article came out. Fortunately, he explains, GERD is usually not serious. Only about 5% of sufferers get Barrett's esophagus, and only 5% of those go on to develop cancer. However, as Dr. Joel Richter, head of gastroenterology at the Cleveland Clinic, points out, "The only way to be sure you don't have these conditions is to have an endoscopy."

That takes all of five minutes, and in two weeks Dr. Meirowitz will snake an endoscope--a flexible tube with a fiberoptic core--down my throat (not pleasant but, he assures me, not as awful as it sounds). If he sees Barrett's, he'll bring me back every year for another look and, if necessary, a biopsy. Under this sort of regimen, my chances of getting cancer will drop dramatically.

In the meantime, I've gone on a so-called proton-pump inhibitor, a new kind of prescription drug that cuts down on acid production. I've also been given a list of changes to make in my life-style. Let's see: I don't drink or smoke or eat fatty foods, so I can't really stop. I'm not obese or even a little overweight, so losing weight won't help. That leaves giving up my beloved caffeine and my even more beloved bedtime snack. We'll see. I'm not making any promises.

To learn more, visit the gastroenterology site at www.acg.gi.org Send questions for Michael Lemonick to mlemonick@aol.com