Patients with GERD benefit from radiofrequency ablation

Greenwich HospitalFeb 9 2012

Heartburn. Acid reflux, GERD. They're different terms for the same type of condition - stomach acid used for digestion travels back up the esophagus, the "food pipe" that connects your throat to your stomach.

Acid reflux causes a burning sensation or extreme discomfort. The acidity can damage the lining of the esophagus, changing its surface so it becomes similar to the lining of the stomach. This esophageal damage is known as Barrett's esophagus, and sometimes leads to dysplasia, or abnormal cell growth, which is considered a precancerous condition. If dysplasia is not found early and removed, patients are at high risk for esophageal cancer, which is often aggressive and difficult to treat successfully.

As recent as 20 years ago it would be common to remove the esophagus in these cases. 10 years ago a gastroenterologist might perform photodynamic therapy, burning the abnormal cells in the lower esophagus. However, that procedure is now considered too invasive, according to Greenwich Hospital gastroenterologist Neal Schamberg, MD.

Schamberg prefers a procedure called radiofrequency ablation, which is now performed routinely at Greenwich Hospital. A balloon-like structure is attached to a catheter and guided through a patient's mouth into the esophagus. The balloon is coated with a metal surface and, when inflated, touches the lining of the esophagus. The doctor administers small pulses of energy, which gently burn the targeted section of bad cells, causing them to die in a controlled manner.

The patient is sedated during the procedure and goes home the same day. The procedure is repeated a few months later to treat residual cells. Most patients have two to four treatments before the precancerous cells in the esophagus are fully removed. "Several studies in recent years have demonstrated that radiofrequency ablation is safe and highly effective at eradicating Barrett's esophagus and preventing cancer formation," said Schamberg.

Barrett's esophagus occurs most often in men. Schamberg says he sees a growing incidence of esophageal cancer, "perhaps because people are living longer, and people have more heartburn, which is related to the rising numbers on obesity in American society."

"For anyone, especially over the age of 40, who is experiencing heartburn several times per week, and relying on over-the-counter reflux medications for daily comfort, a visit with a gastroenterologist is a good idea," said Schamberg, adding "People with Barrett's esophagus will not have symptoms different from typical heartburn symptoms. Therefore, early detection relies on seeing a gastroenterologist to have an upper endoscopy performed. It's a painless screening procedure that takes just a few minutes."

Once you know you have a healthy esophagus, you can help prevent future episodes of heartburn or reflux through lifestyle changes and medications that might include an antacid after meals and at bedtime.

Not everyone is prone to heartburn. If you are, here are some tips from Neal Schamberg, MD, and Greenwich Hospital to prevent GERD (gastroesophageal reflux disease) and complications that may lead to Barrett's esophagus:
1.Eat smaller more frequent meals throughout the day rather than three large meals.
2.Avoid carbonated beverages.
3.Avoid fast foods; they are usually high in trans-fat, and they tempt people to overeat.
4.Limit intake of the specific acid-stimulating foods that trigger your discomfort. These include hot peppers and spicy foods, tomatoes and citrus, coffee, tea and chocolate, among others. Know your personal triggers.
5.Avoid laying down for about two hours after you eat; keep your head slightly elevated at bedtime.
6.Maintaining a reasonable weight.
7.Stop smoking.