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Heartburn? What you need to know about early screenings, warning signs for risk of esophageal cancer

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Nicole Villalpando
Austin American-Statesman

“If you have GERD (gastroesophageal reflux disease), if you have chronic heartburn, you need to speak to an expert,” says Dr. Tripp Buckley, the surgical director of digestive health at UT Health Austin, the clinical arm of Dell Medical School at the University of Texas.

Your esophagus should be monitored for changes that first turn into Barrett’s esophagus and then can become esophageal cancer.

Barrett’s esophagus is a change in the lining of the esophagus that makes it more like the stomach lining. It’s rich with acid and is similar to when a polyp forms in the colon. It puts you at a 40 times greater risk of having esophageal cancer, Buckley says, if that polyp-like part isn’t removed.

Esophageal cancer rates for people younger than age 50 have increased 3 percent every year from 1975 to 2015. In this age group, it’s also caught in more advanced stages. Only about 23 percent of all people with esophageal cancer are still living five years after diagnosis, but cancer that has spread to other parts of the body has only a 5 percent survival rate, according to the American Cancer Society.

We don’t know why cancer rates are going up in younger people, but diet and obesity could be playing more of a role while smoking is playing less of one.

The best way to prevent esophageal cancer it is to prevent the esophagus from turning into Barrett’s esophagus. If that does happen, you should have regular endoscopies to find and then remove the portion of the esophagus that has changed. There is some evidence that removing the part of the esophagus that has become Barrett’s can reverse the Barrett’s, but it’s not a guarantee, Buckley says.

If you have GERD or heartburn more than twice a week, you should be on a screening program of regular endoscopies looking for Barrett’s esophagus and cancer. Difficulty swallowing is also a sign.

Buckley says Barrett’s and later cancer often go undiagnosed because doctors aren’t looking for GERD, Barrett’s or esophageal cancer in younger patients. “We have to have our antennae up,” he says.

He would like regular endoscopies to be done just like people get regular colonoscopies.

Another key to getting a diagnosis of Barrett’s and later cancer is having a good diagnostic endoscopy and a pathologist trained to look for Barrett’s.

UT Health Austin has brought in two different new kinds of biopsy tools and will expand to a third for diagnosing Barrett’s and cancer.

The first uses a specialized brush instead of a wire to get the sample of the esophagus. Buckley says that improves the biopsy by 200 percent.

The optical biopsy is a 3-D biopsy that uses technology developed by the Star Wars program under the Ronald Reagan presidency. That program trained a computer to recognize warheads. That same technology has been trained to identify suspicious tissue. You can look at the esophagus using a real-time microscope image, and the computer will tell you which area looks suspicious and need to be biopsied and checked by a pathologist.

It allows doctors to get a better sample by knowing in which area to look, but it’s an expensive machine, Buckley says, which means many places can’t afford to have it.

The third, which UT Health will begin using next month, is the Lucid Diagnostics EsoCheck. It’s a capsule that is swallowed with a thin string attached. The capsule is inflated and then takes a scraping of cells in the ridges of the capsule. The string is used to bring the capsule back up.

The capsule is placed in a preservation solution and sent for testing. Lucid Diagnostics also has a way of looking at those cells for genetic markers that indicate Barrett’s esophagus or cancer. EsoCheck is similar to the Cologuard stool sample kit for colon cancer. It’s less expensive than an endoscopy and could be done by a family medicine doctor.

“It should be a game-changer,” Buckley says. It will be a less expensive and easier way of getting screened, he says.

UT Health Austin will be participating in a clinical trial to test EsoCheck’s results compared to other ways of diagnosing Barrett’s and esophageal cancer.

For Buckley, Barrett’s and the potential of esophageal cancer is especially important to him because he was diagnosed with Barrett’s esophagus at age 40.

“I did not fit any other profile other than male and white for having even GERD. It can affect anybody,” he says.

This article originally appeared on Austin American-Statesman: Heartburn? What you need to know about early screenings, warning signs for risk of esophageal cancer

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