New Screening for Millions of Acid Reflux Sufferers Could Save Lives
Article Date: Oct 14, 2013

Alegent Creighton Clinic Surgeon Sumeet Mittal, M.D.

Alegent Creighton Health has more primary care physicians touching more lives than any other system in Omaha. Our primary care physicians are on the front lines when it comes to preventing and diagnosing cancer.

It never occurred to Jeffrey Belina that every time he popped a pill for his heartburn, he actually was masking a progressive disease that for him would result in cancer.

Like millions of others, Belina incorrectly believed that taking pills was treating his reflux disease; even though medications suppressed his acid production and relieved his heartburn, the actual reflex continued.

For 35 years, the Clarkson, Nebraska farmer covered up reflux symptoms that eventually led to reflux induced esophageal cancer. Unfortunately, he had Stage 4 disease at diagnosis. It's estimated that 10 to 15 percent of long-term severe reflux sufferers progress to Barrett's Esophagus, a precancerous condition related to acid reflux. Some patients with Barrett's Esophagus, like Belina, progress to esophageal cancer.

Now he makes it a point to inform friends and family about the hidden dangers of reflux.

"I was unaware of the consequences," he said. "If I'd known what they were, I would have had my esophagus checked out a long time ago." It just didn't occur to him that he was masking a progressive disease and that damage to his esophagus from his long-term chronic condition could lead to esophageal cancer.

The number of esophageal cancer cases has grown more than 600 percent since 1975, making it the fastest growing type of cancer in the United States. It's also one of the most deadly—and misunderstood. One in three American adults suffers from heartburn, a symptom of reflux disease. According to RefluxMD, 20 percent of all adults lose sleep, miss work or change their plans because of heartburn symptoms: "The incidence of people suffering from these symptoms is increasing at a rate of 30 percent every decade." Americans spend $14 billion a year on medications such as Prilosec, Prevacid or Nexium, in addition to money spent on Rolaids, Tums and other over-the-counter aids.

RefluxMD declares reflux disease is not a nuisance—it's an epidemic. With the incidence of esophageal cancer rising, early detection is more important than ever.

At age 55, Belina underwent an endoscopy near his hometown when he started having trouble swallowing. Doctors found he had esophageal cancer and referred him to the Esophageal Center at Alegent Creighton University Medical Center for further evaluation. Unfortunately for him, a workup showed his disease was widespread and he had limited options.

Alegent Creighton Clinic Surgeon Sumeet Mittal, M.D., has met with Belina and many other patients like him who have silently suffered heartburn for years. Dr. Mittal is also director of the Esophageal Center: "Everybody, including many physicians, ignores reflux disease, thinking it's not a big deal," said Dr. Mittal. "I need to see them10 to 20 years earlier, before it gets to the point where it's cancerous." He said Belina's case is not unusual: "He had reflux for 30 years or more and now he presents with advanced esophageal cancer. It's tragic."

Dr. Mittal believed the fight against what has been called an "epidemic" should begin with primary care physicians (PCPs), those who know their patients best. Increasing awareness of the potential outcomes of long-term reflux among both patients and physicians is the first step, he said. To help accomplish that, Dr. Mittal has developed a protocol that would teach and equip primary care physicians to screen for Barrett's Esophagus. "There's a need to do it early," he said.

"The more primary care physicians who understand and use an esophageal screening, the more lives we'll be able to save," said Becki Swanson, operations leader for Alegent Creighton Health Oncology Services. "This can prevent patients from developing esophageal cancer years from now because the primary care physician will catch the early warning signs."

Under Dr. Mittal's protocol, PCPs would perform an office-based transnasal endoscopy. That would involve numbing the patient's nose, inserting the transnasal scope and taking a biopsy or photos to screen for Barrett's Esophagus.

The outpatient office-based procedure would cost significantly less than the traditional endoscopy, which is performed when the patient is sedated. "Hopefully, with widespread availability of this ‘cheaper' and ‘easier' screening—along with greater awareness about esophageal cancer—it would help save lives," he said.

Belina currently is undergoing chemotherapy and radiation to fight the cancer. He became encouraged recently when doctors told him his progress so far has been "remarkable."

It's recommended that anyone with more than five years of reflux, especially caucasian males, get a screening—with either the traditional endoscope where the patient is sedated or with the new office-based unsedated endoscopy. Anyone with a family member who had esophageal cancer should also be screened.

Dr. Mittal said he's seen a lot of interest in the office-based transnasal endoscopy from Alegent Creighton Clinic primary care physicians: "We could change the way we take care of patients," he said. "This could be a model for the entire country."

The Esophageal Center is located at Alegent Creighton University Medical Center and is recognized as a national leader in the diagnosis and treatment of benign and malignant esophageal diseases. This reputation can be attributed to the dedication of its physicians and staff, whose combined experience and commitment to excellence has allowed them to perform more procedures than any other center in the region.

For more information, call 402-280-4161.


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Related Links
Sumeet Mittal, M.D.

Esophageal Center

Barrett's Esophagus

Cancer Center