Gastroesophageal reflux (GERD) is a condition in which stomach acids back up into the esophagus. There is a muscular ring of tissue (called a sphincter) at the end of the esophagus, where it meets with the opening into the stomach. The sphincter acts like a valve. When food and liquids are swallowed, the sphincter relaxes, allowing digestive contents to enter the stomach. The sphincter then closes to prevent the contents from coming back up. Sometimes stomach acids and partially digested food manage to leak back into the esophagus. This is called acid reflux and is usually associated with overeating or excess pressure on the stomach after eating. Patients may complain of heartburn, indigestion or excess gas. Occasional reflux is usually considered normal. However, when heartburn becomes more frequent, it is a medical problem, called GERD.

According to the National Heart Burn Alliance, up to 20 percent of Americans have frequent heartburn and may have GERD. Obesity, pregnancy and smoking increase risk for the condition. Certain foods, like citrus fruits, alcohol, chocolate and tomato-based meals, may also trigger symptoms.

Barrett's and Esophageal Cancer

Acid reflux can irritate the cells that line the esophagus. Over time, those cells are eventually replaced by the same cells that line the small intestine. This abnormal condition is known as Barrett's esophagus.

The National Institute of Diabetes and Digestive and Kidney Diseases estimates about 700,000 adults in the U.S. have Barrett's esophagus. The condition occurs in about 10 percent of those with GERD. Most patients are over 60 at the time of diagnosis. Men are affected two times more often than women.

The major concern with Barrett's esophagus is an increased risk for esophageal cancer. NIH experts say people with Barrett's are at least 30 times more likely to develop esophageal cancer than those without the condition. However, individual risk is still small. Every year, only about one percent of patients with Barrett's is diagnosed with esophageal cancer.

Doctors usually recommend regular esophageal cancer screening for patients who are found to have Barrett's esophagus. Tissue samples are taken from the lining and examined under a microscope. If cancer is detected, most of the esophagus may be removed to eliminate the disease. The stomach is then pulled up and reattached to the remaining section of the esophagus.

Treating Barrett's: RF Ablation

Some physicians are now using a newer treatment for Barrett's esophagus, called radiofrequency (RF) ablation. The HALO technology (BARRX Medical Inc.) uses heat to destroy the abnormal cells in the esophageal lining (the Barrett's cells), hopefully reducing the risk for or preventing the development of esophageal cancer.

Virender Sharma, M.D. is a Gastroenterologist/Hepatologist with Mayo Clinic in Scottsdale, AZ. He says RF ablation is done as an outpatient procedure using sedation. An endoscope (lighted viewing tube) and balloon-tipped catheter are placed into the esophagus. RF electrodes are coiled around the outside of the balloon. Once the tip of the catheter has reached the target area, the balloon is inflated, placing the electrodes directly in contact with the esophageal lining. Next, RF energy is delivered through the electrodes, creating heat that destroys the contact tissue. The depth of the burn is based on the amount of energy the physician releases through the electrodes.

After the treatment, patients are given pain medications to control post-operative discomfort and swallowing problems. In most cases, these symptoms go away in three to four days. Patients are also given anti-reflux medication to control GERD symptoms and promote healing of the esophageal tissue.

The HALO System has been approved by the FDA. Sharma says a follow-up study has found more than 98 percent of patients had no signs of Barrett's disease three years after the treatment. No one knows how long the effects will last. So doctors will follow these patients for the next ten years.

According to Sharma, RF ablation is not a cure for GERD and patients can develop Barrett's esophagus again. So it's very important for patients to keep their GERD symptoms under control by taking their anti-reflux medications.

For information about the HALO system or treatment, or to locate the nearest physician:

BARRX Medical, Inc.

For general information on heartburn, GERD or Barrett's Esophagus:

American College of Gastroenterology

American Society for Gastrointestinal Endoscopy

National Heartburn Alliance

National Institute of Diabetes and Digestive and Kidney Diseases