Over the last 30 years things have changed significantly. The incidence of adenocarcinoma has been rising steadily, to the point where today this type of cancer now accounts for the majority of esophageal malignancies. A number of theories have been suggested as to why this dramatic change has occurred, but there is no proof as to the actual cause. We know that unlike squamous cell cancers these tumors are more common in caucasian men who have chronic symptoms of acid reflux. Repeated acid injury is well known to be associated with the development of a condition known as Barrett’s esophagus, where the esophageal lining changes into tissue that looks more like the lining of the stomach. These abnormal areas of mucosa are at further risk for undergoing additional changes that can culminate in adenocarcinoma. Although the incidence of Barrett’s esophagus is still relatively low in the population in general, it has been steadily rising and along with it the risk of this type of cancer.  

The presence of Barrett’s changes can only be determined by inspecting the inside of the esophagus with an endoscope. This procedure is commonly referred to by one of several different name: upper GI endoscopy, esophagogastroduodenoscopy, EGD, or sometimes just a scope. During the procedure biopsies can be taken of any suspicious appearing tissues, and if Barrett’s is confirmed appropriate treatment is then recommended. There are some promising new endoscopic treatments available to treat Barrett’s, but in general the primary way to manage the problem is to aggressively control the reflux of acid from the stomach up into the esophagus. This can be accomplished either with daily medications that suppress stomach acid production, or by performing a surgical procedure to improve the function of the failed anti-reflux barrier between the stomach and esophagus. 

Unfortunately, esophageal cancer has few if any early symptoms, but as it progresses patients typically complain of increasing difficulty swallowing. These malignancies are extremely difficult to treat successfully unless they are diagnosed very early, long before there are any symptoms. The most effective treatment is often the surgical removal of the esophagus, an extremely challenging and potentially disabling procedure. Radiation and chemotherapy can also be used to treat patients with esophageal cancers, but once again, a successful outcome depends largely on making an early diagnosis. 

So what’s the bottom-line? If you suffer from chronic heartburn, even if its reasonably well controlled with either prescription medications or over the counter drugs, you should, at some point, have an endoscopic examination to check for Barrett’s esophagus. This is especially true if you are a caucasian man over the age of 50, but actually anyone who has chronic reflux is at risk. Esophageal cancer is largely preventable, and controlling your acid reflux is the single most important thing you can do to protect yourself. As you’ve heard on countless television ads for the various acid reflux medications, it could be something more than just a little heartburn. If you have any questions about Barrett’s or esophageal cancer consult your doctor.

As a surgeon I sat and watched the events unfold on television last Saturday and I was struck by how efficiently the emergency medical system responded to this major disaster. This was not some pre-rehearsed disaster drill, rather this was the real thing! On just another lazy Saturday morning I’m certain the emergency department at the University of Arizona Medical Center was in the process of seeing a few minor injuries, a couple of children with fever, and perhaps an elderly gentleman with chest pain. Suddenly, they were in the middle of what must have felt like a war zone. Helicopters and ambulances were arriving one after the other with critically injured patients including Congresswoman Gabriel Giffords. To describe such a scene as chaotic would be an understatement.

It’s truly remarkable how a civilian hospital and the personnel who work there were capable of shifting gears, becoming a major disaster management center in just a matter of minutes. It’s my understanding that 10 separate gunshot victims arrived at the University Medical Center, and all but one of them survived. The lone exception was nine-year-old Christina Green who had been shot in the chest. Regrettably, nothing could be done to reverse the mortal wound she suffered. As for the others, including representative Giffords, they were quickly and expertly transported into operating rooms where life-saving care was administered.

Over the last three and a half decades I have spent countless hours in hospital emergency departments caring for a variety of sick and injured patients including victims of trauma, and I can assure you that the remarkable actions of the trauma team in Tucson did not occur by accident. Trauma teams across the nation train regularly for such events and stand ready to deal with them whenever and wherever they may occur. So, if there is one thing positive that should come out of this tragedy, it is the realization that physicians and nurses and a variety of support personnel are ready and capable of dealing with even the most horrific acts of human violence or natural disaster. The results may not always be perfect, in fact sometimes an injury or illness is simply irreversible, but with God’s help the tireless efforts of dedicated individuals can, and often do, produce phenomenal results. 

One final point: Over the last several years the national discussion surrounding health care in the United States has consistently pointed to various statistics suggesting that we have less than quality care at a higher price than elsewhere in the world. Personally I reject that notion and would point to the events of January 8, 2011, in Tucson, Arizona as proof of the exceptional standards of American medicine.

RESOLVED, That our American Medical Association immediately formulate legislation for an additional payment option in Medicare fee for service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule and in a manner that does not forfeit benefits otherwise available to the patient. This legislative language shall be available to our AMA members no later than September 30, 2010.

The resolution passed by an overwhelming margin of 73% to 27% and is now official AMA policy. It is our opinion that the future of American healthcare can be ensured if we empower out patients by providing them with clear choices. Next week I will be traveling to Washington, DC along with several other co-sponsors of the resolution to work with AMA staff to finalize the language in this bill. The AMA will then work to find champions in Congress willing to introduce this legislation shortly after the new Congress is seated in November. There is much work to be done, and it is time for physicians to take the lead.