Study finds that heat is effective in treating throat condition

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ASSOCIATED PRESS – Zapping away abnormal, precancerous cells in the throat may lower the risk of later developing esophageal cancer, the first major study to test this technique finds.

In a study of 127 people suffering from a heartburn-related problem known as Barrett’s esophagus, only about one% who had a procedure that uses heat to burn off precancerous spots went on to develop cancer over the next year. That’s compared with more than nine% of those who got a fake treatment in which no cells were destroyed.

What is Barrett’s esophagus? Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that connects the mouth to the stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia.

No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus.

Barrett’s esophagus affects about 1% of adults in the United States. The average age at diagnosis is 50, but determining when the problem started is usually difficult. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races. Barrett’s esophagus is uncommon in children.

What is gastroesophageal reflux disease (GERD)?

GERD is a more serious form of gastroesophageal reflux (GER). GER occurs when the lower esophageal sphincter opens spontaneously for varying periods of time or does not close properly and stomach contents rise into the esophagus. GER is also called acid reflux or acid regurgitation because digestive juices called acids rise with the food or fluid.

When GER occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD.

Persistent reflux that occurs more than twice a week is considered GERD and can eventually lead to more serious health problems. Overall, 10 to 20 percent2 of Americans experience GERD symptoms every day, making it one of the most common medical conditions. People of all ages can have GERD.

Barrett’s esophagus occurs when stomach acid backs up into the throat, causing the normal lining to be replaced by abnormal growth. Barrett’s sufferers are 30 times more likely than others to develop esophageal cancer, one of the deadliest forms of the disease.

Scientists do not know what causes esophageal cancer, but some suspect smoking, drinking and obesity may play a role. The American Cancer Society estimates 16,470 people will be diagnosed with the disease this year, and incidence has been rising. An estimated 1,600 new cases will be diagnosed in Canada, according to Canadian cancer statistics.

Doctors typically perform down-the-throat exams and surgically remove the esophagus in severe cases of Barrett’s. A less drastic alternative, which has been available since 2005, uses a device down the throat and radiofrequency energy to destroy precancerous cells.

In the study published in Thursday’s New England Journal of Medicine, Barrett’s patients who had signs of precancerous cells were treated with the device or given a sham procedure that did not involve heat.

After a year, 77% who had the procedure were free of precancerous spots compared with two% who got the fake treatment.

More Barrett’s patients who underwent the heat procedure had pain for about a week afterward. One in the heat group suffered gastrointestinal bleeding and five developed narrowing of the esophagus.

Still, the study had a low complication rate, Dr. Jacques Bergman of the Academic Medical Center in Amsterdam wrote in an accompanying editorial.

The study was led by Dr. Nicholas Shaheen of the University of North Carolina at Chapel Hill. Several researchers and Bergman have received grants from or have other financial ties to Sunnyvale, Calif.-based Barrx Medical Inc., which makes the device and paid for the research.

The procedure, which takes about 30 minutes and is done in outpatient offices, costs about US$2,000. It is covered by Medicare in the U.S. and most insurance plans.

However, it’s not for everybody with Barrett’s: Not all have precancerous cells and Bergman said it is too early to recommend it to Barrett’s sufferers who show no signs of abnormal spots.

On the Net:

New England Journal: http://www.nejm.org