Spring 2009
Turning Back the Clock on Disease
Turning Back the Clock on Disease

Bill Haberlin of Trumbull underwent a new, non-surgical procedure to protect himself from developing esophageal cancer.

For most adults, eating is a pleasure and something to look forward to. Whether it’s the crunch or creaminess, the sugar or spice or simply the taste of a favorite food, a meal or snack can be the best part of the day. But for those managing a chronic health condition that’s directly related to food, this basic joy can become an unpleasant chore.

For more than 20 years, Bill Haberlin of Trumbull suffered from gastroesophageal reflux disease (GERD), also known as acid reflux. He experienced heartburn—a burning feeling in the chest behind the breastbone—after every meal. Sometimes he had a sour taste and a burning sensation in his throat. “Taking antacids helped,” he says. “So I carried around bottles of it wherever I went. I had a bottle in my car, one in my briefcase, one on my desk at work and one on my nightstand. I didn’t go anywhere without antacids.”

Bill’s symptoms—the burning in his chest and throat, the sour taste—were caused by acid that traveled in the wrong direction…from his stomach back up into his esophagus. The culprit was Bill’s faulty lower esophageal sphincter (LES—a muscular ring where the esophagus meets the stomach). The LES wasn’t closing properly after he ate or drank. (See illustration on page 2.) When the LES opened at the wrong time or didn’t close tightly enough, stomach acid went up into Bill’s esophagus and caused his symptoms.

For years, Bill visited his gastroenterologist, Gregory Soloway, MD, who treated Bill’s GERD with acid blockers (prescription medication) as needed. Dr. Soloway regularly examined and tested Bill’s esophagus for damage with a five-minute test called an upper endoscopy.

An upper endoscopy test involves sedating the patient and then passing an endoscope (a long, flexible tube with a light and video camera on one end) through the mouth to look at the esophagus (as well as the stomach and the first part of the small intestine called the duodenum). In addition, the physician takes a sample of tissue (this is called a biopsy). In Bill’s case, it was from the lining of the esophagus.

Then, about a year ago, one endoscopy and biopsy revealed that the repetitive wash of stomach acid on Bill’s esophagus caused him to develop a serious condition. Bill had Barrett’s esophagus.

Barrett’s esophagus is typically diagnosed in men who are middle-age or older and who, like Bill, have had GERD for many years. Over time, the cells that line the esophagus are destroyed by the acid and are replaced by cells that can lead to esophageal cancer. Approximately 1 in 200 people with Barrett’s esophagus will develop esophageal cancer each year.

“Until recently, patients with Barrett’s esophagus had only one option: watch—with routine endoscopies— and wait,” says gastroenterologist Andrew Bedford, MD, one of Dr. Soloway’s partners. “When cells in the esophagus begin to change into cancer, it is called dysplasia. For those whose Barrett’s turned into cancer, surgery to remove the esophagus became necessary.”

Surgical removal of part or all of the esophagus is a difficult and long (four to eight hours) procedure. “After the esophagus is surgically removed, the stomach is moved up into the neck,” says Chief of Gastroenterology George Abdelsayed, MD. “Following surgery, the patient’s quality of life is significantly impaired. Patients may have trouble with a regular diet and may have to eat softer or mashed foods, avoid liquids at meals and stay upright for one to three hours after eating.”

Bill knew the devastating effects an esophagectomy (surgical removal of the esophagus) could have on a person’s lifestyle. “One of my good friends had Barrett’s,” he says. “It developed into esophageal cancer and he had his esophagus removed. That’s something I’d never want to experience.” And with his own Barrett’s diagnosis, Bill was deeply worried.

Then his worst fears were suddenly alleviated. Dr. Soloway and Dr. Bedford determined that Bill would be a good candidate for a new procedure for treating Barrett’s esophagus.

“I got a call from Dr. Bedford out of the blue last fall,” remembers Bill. “He told me about a new, state-of-the-art treatment that might help eliminate my Barrett’s, and that Bridgeport Hospital had the equipment to do it.”

Dr. Bedford has particular expertise in this gentle, non-surgical option: radiofrequency ablation (RFA). RFA uses bursts of energy to pinpoint and destroy pre-cancerous cells in a patient’s esophagus. If done early enough, the abnormal tissue will not turn into cancer.

“When Dr. Bedford asked me if I’d be interested in having this procedure, I burst out with, ‘You can count me in as long as you don’t have to cut me open!’ After hanging up the phone, I immediately went online to research the technique,” Bill remembers. He called Dr. Bedford back about an hour later. “I told him, that’s the procedure for me. I’m a preventive kind of guy and I want to do everything I can to prevent the Barrett’s from developing into cancer. The thought of cancer was always in the back of my mind. I was going for endoscopies and biopsies at regular intervals and I would always hope the doctor would tell me, ‘Yep, all’s clear. See you next time.’ You never, ever want to hear that it’s developed into something else.”

A few weeks later, Bill was accompanied by his wife, Carol, to Bridgeport Hospital for the 40-minute procedure. After Bill was sedated, Dr. Bedford inserted a thin tube (called a catheter) fitted with a tiny balloon into Bill’s esophagus. Dr. Bedford inflated the balloon to open up the area of the esophagus to be treated and then delivered short bursts of energy to heat the tip of the catheter. With a light touch, the catheter destroyed the diseased tissue on the very surface lining of Bill’s esophagus without harming the healthy surrounding areas or layers of skin. Dr. Bedford then gently and easily scraped off the abnormal cells.

“After just one session, this procedure can destroy 98 to 100 percent of the diseased tissue,” says Dr. Abdelsayed. “If new abnormal cells develop, the procedure may be repeated.” Most patients who receive RFA to treat Barrett’s esophagus never need surgery.

“Research shows that the most common side effect patients experience is temporary, mild pain in the chest area, which is easily managed with medication,” continues Dr. Abdelsayed.

“For about a week, it hurt to swallow,” remembers Bill, “but I was back at work the very next day after the procedure— and it was a Friday!”

“This is a procedure that can prevent cancer cells from developing in the esophagus,” says Dr. Bedford. “More than 90 percent of patients are free of Barrett’s after this procedure. Just as removing polyps from the colon reduces the risk of colon cancer, removing Barrett’s cells allows patients to rest assured that they are doing the utmost to protect themselves from developing esophageal cancer.”

Bill is thrilled with the results. “Today, my doctor says that more than 90 percent of the area is covered in healthy tissue, reversing the years of damage to my esophagus,” he says. “I am so pleased I had the procedure. I feel like a thousandpound weight of ongoing stress and worry has been lifted from my shoulders. I couldn’t be happier!”

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