ME AND MY OPERATION: Blast of heat reduces the damage of chronic heartburn

Persistent heartburn can lead to changes in the gullet lining, which can potentially lead to cancer. Jacki Skelding, 64, a part-time administrator from Cambridgeshire, underwent a minimally invasive treatment for it, as she tells OONA MASHTA.

THE PATIENT

Since the birth of my son 32 years ago, I suffered from increasingly frequent heartburn. At first, I could control it by cutting out foods such as citrus fruit and curries.

Jacki Skelding, 64, suffered from heartburn which developed into Barrett’s Oesophagus Dysplasia (BOD)

But by my mid-40s my diet was becoming more limited as more and more foods gave me heartburn. I had to have just one meal a day, in the evening.

Finally, in 1996, I decided to see my GP, who referred me for an endoscopy – where they used a tube with a camera to examine my gullet.

This showed I had a hiatus hernia, where part of your stomach squeezes up into the chest, affecting the valve at the bottom of the gullet – this was letting acid splash up, giving me heartburn. They can’t do much for the hiatus hernia, so my GP prescribed Gaviscon for the heartburn. This became my saviour for the next 15 years.

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But as time went on I began to have difficulty swallowing, I would often gag during meals and sometimes had to be sick afterwards.

Then, in early 2013, I had a wake-up call. My neighbour died of oesophageal cancer soon after she was diagnosed. It really frightened me because she’d had heartburn symptoms identical to mine. So I went back to my GP.

This time he prescribed me a proton pump inhibitor (PPI), a drug that reduces acid in your stomach.

This which can potentially develop into cancer, and Jacki’s cells had become pre-cancerous

He also referred me for another endoscopy, where they told me my gullet was so inflamed that it was difficult to see the lining clearly. I was told that there was a risk that I might have Barrett’s oesophagus, abnormal cells in the gullet that can become cancerous.

My PPI dose was gradually increased until it was up from the original 10mg to 80mg a day and, after another endoscopy in September 2013, I was referred to a consultant gastroenterologist.

He diagnosed Barrett’s oesophagus and said the cells had become pre-cancerous.

It was quite a shock and memories of my neighbour came flooding back. After leaving the hospital, I had a good cry.

Fortunately, I was told they could treat it. I would either have part of the oesophagus cut away, or a new procedure called radiofrequency ablation (RFA), where they burn away the pre-cancerous tissue, which I preferred the sound of.

But the doctors would only decide which to do once I was sedated and they could assess the extent of the problem.

I went in for treatment in November, and in the recovery room I discovered I’d had RFA.

Afterwards, I had a sore throat, but was back at work the next day. I was on liquids for a few days, then soft food for a week.

Then, in January 2014, I had a second treatment. My sore throat lasted a week this time.

But afterwards I was delighted that I could eat more than I had done for years without suffering from heartburn or being sick.

After biopsies in April and November 2014, the doctor confirmed there was no sign of Barrett’s oesophagus or the precancerous cells. I am now having annual checks, and my PPI dose is down to 40mg.

I should have taken my heartburn seriously, but I think I have had a lucky escape. If I had left it much longer, the prognosis could have been far worse.

She has now had a new procedure called Radio Frequency Ablation RFA which has reversed her BOD

THE SPECIALIST

Dr Massimiliano di Pietro is a consultant gastroenterologist at Addenbrooke’s Hospital, Cambridge.

Seven million Britons have acid reflux, and the most common symptom is heartburn.

Acid reflux occurs when acid leaks out of the stomach into the oesophagus, or gullet – it is usually due to the valve at the bottom of the gullet becoming weakened. When acid reflux happens regularly, it can irritate and inflame the gullet lining.

Initially, doctors may recommend lifestyle changes, such as avoiding excess fatty food. If these don’t work, doctors can prescribe drugs such as PPIs, which work by reducing the amount of acid the stomach produces.

Occasional heartburn is not dangerous, as the cells in the gullet that are burned by the stomach acid will heal.

However, persistent reflux can damage these cells and about one in ten chronic heartburn sufferers will develop this condition, called Barrett’s oesophagus.

Although these abnormal cells are not cancerous, there is a risk that over time they can change in such a way that makes them prone to becoming so. When the cells become pre-cancerous, it is known as dysplasia.

‘After biopsies in April and November 2014, the doctor confirmed there was no sign of Barrett’s oesophagus or the precancerous cells’

Only about one in 300 Barrett’s oesophagus patients develop cancer each year. It’s a very aggressive cancer, and fewer than 15 per cent of patients survive after five years. Early diagnosis is therefore crucial.

Patients who don’t have dysplasia are usually offered regular check-ups. For those with dysplasia or early cancerous changes, until ten years ago treatment involved removing about two-thirds of the oesophagus and making a new one from part of the stomach.

However, this is major surgery and can be fatal, so scientists looked for less invasive treatments.

In the past we used photodynamic therapy, which involves giving the patient a drug that makes the Barrett’s cells more sensitive to light and then exposing the gullet to light to burn them away.

However, this also makes skin very light-sensitive and could cause severe sunburn. It can also shrink the gullet.

The more recently developed radiofrequency ablation (RFA) is a well-tolerated, effective and long-lasting protection against oesophageal cancer.

This minimally invasive procedure, also known as BarrX, is carried out with the patient under sedation on an outpatient basis. It was approved by NICE, the National Institute for Health and Care Excellence, in 2010.

The treatment uses heat to burn away pre-cancerous or cancerous tissue. Electrodes are attached to the tip of the endoscope, which we then insert into the gullet.

We apply a rapid burst of radiofrequency energy – which generates heat – to the lining of the gullet. It is repeated until all the diseased tissue has been ablated, which takes around 15-20 minutes. Patients need on average two to three treatment sessions.

Following the treatment, new healthy oesophageal tissue grows in three to four weeks.

In the interim, there is usually a lot of inflammation, which can cause chest pain and swallowing problems. The patient will also need strong anti-acid medications such as PPIs for a while after the procedure to prevent damage to the new tissue.

In the UK we are continuously monitoring the efficiency and safety of RFA through a registry collating data of patients – it is led by University College Hospital in London.

Now we have long-term data that confirms the non-invasive procedure eradicates Barrett’s oesophagus and can provide a long-lasting protection against oesophageal cancer.

WHAT ARE THE RISKS?

• There is a 5 per cent risk of the gullet narrowing.
• There is a one in 100 risk of bleeding, and a one in 100 risk of a tear in the oesophagus.
• Very rarely, the treatment can induce an abnormal heart rhythm.
• There is a 15 per cent risk of Barrett’s oesophagus returning five years later. ‘Radiofrequency ablation is very safe and has been extensively researched over the past eight to nine years,’ says Professor Grant Fullarton, a general surgeon who runs the Digestive Health Clinic at Ross Hall Hospital, Glasgow. ‘We now have a very effective treatment which prevents cancer and saves lives.’