published Thursday, March 26th, 2009

Donohue: Small number of heartburn patients at risk for cancer

DEAR DR. DONOHUE: Please talk about Barrett’s esophagus. You see TV commercials talk about heartburn and acid reflux, but you don’t hear how, if left unattended, a more serious condition can arise. I have just been diagnosed with Barrett’s, and now I am at a crossroad with my health. Finding out that Barrett’s can be a precursor of esophageal cancer is not advertised. I am worried that I have a life-threatening condition. Would drinking aloe vera formulations help? — Anon.

A: Heartburn (gastroesophageal reflux disease, GERD) is a common disorder, affecting 20 percent of the population. In a small number of heartburn patients, the upward splashing of stomach acid into the esophagus — the swallowing tube — changes the appearance of cells lining the lowermost part of that tube. Those changes are called metaplasia, and that is Barrett’s esophagus. In a smaller number, these changes progress and become dysplasia, a change that is a prelude to cancer. And in a very small number, dysplasia becomes cancer. So, yes, the threat of cancer, small as it might be, does loom for those with Barrett’s esophagus. Medicines called proton pump inhibitors turn off acid production and are prescribed for all Barrett’s patients. They’re also prescribed for people with ordinary heartburn. Some of their names are: Prilosec, Prevacid, Nexium, Protonix and Aciphex. An essential part of Barrett’s treatment is a schedule of scope examinations of the lower esophagus to catch cancer changes early. If those changes take place, a number of options are open for dealing with them. Radio waves, a laser beam or a technique employing medicines called photo sensitizers with subsequent exposure to a special light (photodynamic therapy) can wipe out the cancer cells. All these methods are done with a scope and instruments — no cutting involved. Other methods exist, and so does surgery for situations that don’t lend themselves to scope procedures.

In a sense, you’re lucky. You have been diagnosed, and you’re going to get immediate care should cancer change take place. For every one person diagnosed with Barrett’s, 20 go undiagnosed. They are the unlucky ones.

Aloe vera will not help.

Heartburn, hiatal hernia and GERD are discussed in detail in the booklet on those topics. Readers can obtain a copy by writing: Dr. Donohue — No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My wife has Alzheimer’s disease and is in a clinical trial of a medicine for it. She also takes Lexapro, Lescol, Aricept and a blood pressure medicine. She has got it in her mind that she can’t have bananas because of one of the medicines she takes — a potassium effect or something. It sounds like nonsense. I would like your take on this. — E..C.

A: None of the three medicines you mentioned is incompatible with potassium or potassium-rich foods. I bet it’s her blood pressure medicine, an ACE-inhibitor. Names of commonly prescribed ACE-inhibitors are captopril, Lotensin, Vasotec, Monopril, Zestril, Univasc, Accupril and Altace. People who take potassium supplements or potassium-sparing water pills and are also taking an ACE-inhibitor can experience a rise in their blood potassium. Potassium foods don’t usually cause such a rise. A banana has 420 mg of potassium. It is surpassed by lima beans, which weigh in at 950 mg per cup; a cup of squash at 900 mg; a cup of spinach at 840 mg; a baked potato with skin at 800 mg; a cup of yogurt at 600 mg; and a cup of orange juice at 500 mg. To be consistent, whoever told her not to eat bananas should have told her not to eat these foods. To be safe, check with her doctor. Perhaps the trial drug she’s on might be the reason for the ban.

DEAR DR. DONOHUE: I am 21. Two years ago I began a severe, calorie-restricted diet. I was diagnosed as having an eating disorder. My hair thinned considerably. I am now eating more healthily. Will my hair grow back? — A.K.

A: Hair growth almost always takes place once sufficient calories are brought back into the diet.

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