Photodynamic therapy may become the first line of treatment for Barrett's esophagus

Apr 7 2006

When you think of heartburn, you probably think of greasy food, not cancer. You may not know that chronic heartburn is linked to esophageal cancer.

Most people experience occasional heartburn. But when heartburn is severe or occurs frequently over an extended period of time, it is called Gastroesophageal Reflux Disease or GERD. Over time, untreated GERD damages the lining of the esophagus. As a result, one in 10 people with GERD develop Barrett's esophagus, a potentially dangerous change in the lining of the esophagus. Barrett's esophagus occurs when acid-resistant cells, similar to those found in the stomach and intestinal lining, grow in the esophagus.

"Many patients with Barrett's esophagus experience no symptoms," said Dr. Luis Peqa, UK College of Medicine Assistant Professor, Division of Digestive Diseases and Nutrition. "It is important to go to your doctor, if you are experiencing persistent or severe heartburn. If acid reflux is controlled, you may not develop Barrett's esophagus."

Preventing Barrett's esophagus could be a matter of life or death: Those with Barrett's esophagus may be 30 times more likely than the average person to develop esophageal cancer. Survival rates for the nation's fastest growing cancer are staggering: Only 16 percent survive five years after diagnosis. The American Cancer Society estimates that nearly 14,000 will die from esophageal cancer this year.

It is standard to monitor Barrett's esophagus for dysplasia, or abnormal cell changes, through endoscopy. During an endoscopy, the patient is sedated and a thin, lighted tube is inserted down the throat, allowing the doctor to examine the lining of the esophagus for abnormalities and to biopsy, or collect tissue samples for testing. In patients with high-grade dysplasia, 20 percent may develop cancer. Thus, serious measures must be taken.

Typically, this means undergoing an esophagectomy, the removal of the esophagus. But this procedure has its risks - complications such as problems swallowing and a three to 13 percent mortality rate, depending on the expertise of the surgical center.

"This is major surgery, and for some patients it is not an option," Peqa said. "If a patient is too ill or elderly to undergo an esophagectomy, we offer an alternative in photodynamic therapy."

The University of Kentucky HealthCare Chandler Medical Center is one of only two centers in Kentucky offering photodynamic therapy, which reduces the incidence of esophageal cancer. The outpatient procedure involves injecting the patient with a photosensitizer intravenously. Two days later, the photosensitizer is activated with a laser, and abnormal cells are destroyed. The patient must return for an endoscopy in three months and the process can be repeated if necessary.

Although photodynamic therapy carries much less risk of death than esophagectomy, patients need to be aware of its risks. There is a 20 to 40 percent chance of stricture, an abnormal narrowing of the esophagus, which is treated with dilation. Patients will be severely light sensitive for four to six weeks after the procedure and must take care to cover their entire body before exposure to sunlight. They can gradually increase sun exposure as the photosensitizer dissipates from their system. Patients can expect chest pain and/or difficulty swallowing for a week or two after the treatment. Pain can be controlled with medication.

"Right now, we don't have long-term data on outcomes," Peqa said. "In time, photodynamic therapy could become the first line of treatment, or a more widely used alternative to esophagectomy."