Recently, Gastrointestinal Associates teamed up with Thompson Cancer Survival Center to make this advanced treatment available to gastrointestinal patients in East Tennessee. Two patients have already benefitted from brachytherapy in our first month of offering the treatment.

Brachytherapy (brak-e-THER-uh-pee), sometimes called internal radiation, is a procedure that involves placing high-powered radiation inside your body, right at the site of the cancerous tumor. Unlike conventional radiation therapy which projects a beam of radiation from a machine outside of the body, this therapy allows physicians to deliver higher doses of radiation to more specific target areas with much fewer side effects.

For esophageal cancer, the brachytherapy radiation tube/seeds are placed in the esophagus during an endoscopic procedure while the patient is sedated. The actual radiation time varies between 5-10 minutes and two treatments are given over a 2 week period. For other areas of the body, ultrasound, x-ray and other imaging techniques enable the physician to place the radiation in the most effective position in relation to the tumor.

Brachytherapy for certain cancers has been shown to be as effective as surgery or external radiation and even more effective when used in combination with the other therapies. Since this procedure reduces radiation exposure and damage to healthy tissue near the tumor, it causes fewer side effects than conventional therapy. The treatment time is also usually shorter with brachytherapy.

Brachytherapy is an effective treatment for many types of cancer, particularly small or locally advanced tumors. It has been most commonly used to treat cervical, prostate, breast and skin cancers. Now we are able to add esophageal cancer to the list.

With new systems in place to reduce the risk of unnecessary radiation exposure to both the operator and patients, and new imaging technologies that make placement more precise, this procedure is an important tool in treating esophageal cancer.

We are pleased to be able to offer the benefits of brachytherapy to our patients at GIA.

Heartburn affects many of us. In fact the American Gastroenterological Association reports that more than 60 million Americans experience symptoms at least once each month.

The burning sensation you feel is actually stomach acid splashing up into your esophagus. A valve at the end of the esophagus, called the lower esophageal sphincter (LES), normally prevents this. But factors such as overeating, pregnancy or even stress can keep the valve from shutting properly. When that happens, stomach acid can be pushed back up into the esophagus, causing pain along with a sour or bitter taste in the mouth.

Occasional heartburn is normally nothing to worry about and can easily be treated with over-the-counter antacids. However, frequent heartburn may indicate a more serious problem. Over time, stomach acid can damage the wall of the esophagus and, if left untreated, can lead to narrowing of the esophagus, bleeding and trouble swallowing, a condition called Barrett’s esophagus, and even cancer of the esophagus. Prolonged heartburn may also indicate more serious problems such as acid reflux disease, gastroesophageal reflux disease (GERD), gastritis, hiatal hernia or peptic ulcer.

There are several lifestyle changes you can make to help avoid heartburn:

• Avoid trigger foods such as chocolate; coffee; peppermint; spicy or greasy foods; tomato products; and alcoholic beverages.
• Eat smaller , more frequent meals.
• Don’t go to bed with a full stomach. Give food 2-3 hours to digest before going to bed.
• Stop smoking or using tobacco in any form. Tobacco inhibits saliva, the natural protection for your esophagus and the nicotine in tobacco increases acid secretion and relaxes the LES.
• Shed some pounds. Losing weight can help relieve symptoms.
• Eat high-protein, low-fat meals.
• Drink plenty of water during exercise to keep from being dehydrated.
• Avoid tight clothes and belts.

If you still experience heartburn, antacids usually give fast, short-term relief. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide to reduce the chance of diarrhea or constipation. If your symptoms worsen when lying down, raising the head of your bed so that your head and chest are higher than you feet may help.

If symptoms persist or occur frequently, speak to your doctor. Continuous heartburn may indicate a serious problem, and sudden chest pain may be mistaken for heartburn when it is really a sign of heart disease. Your physician may suggest prescription medication or testing such as x-rays to check for ulcers, pH tests to check for acid in the esophagus, or endoscopy to look for other conditions. Seek medical attention when the following symptoms occur:

• Difficulty or pain when swallowing
• Vomiting blood
• Black or bloody stools
• Shortness of breath
• Lightheaded or dizziness
• Neck or shoulder pain
• Heartburn more than 2-3 times per week for more than 2 weeks.

If heartburn is becoming a more frequent problem, keep a heartburn record. Track how often you experience the symptoms, what time of day and what you are eating or doing when the symptoms occur. That will help you get a clearer picture of when it is time to seek medical care and help your doctor more effectively diagnose and treat your condition.

EE is sometimes confused with gastroesophageal reflux disease (GERD) because the symptoms of the diseases are so similar.

EE has been detected in all ages and on every continent, except Africa. Our team here at Gastrointestinal Associates (GIA) is familiar with the latest research on EE and has experience treating the disease.

People that are most at risk for EE are white males in their late 30s. Women and children are less susceptible but still can suffer from the condition. If your family has a history of allergy conditions, you are more likely to develop the disease.

EE is perhaps caused by an allergic reaction to food, chemicals or airborne particles. White blood cells called eosinophils build up in the esophagus as a response to the allergens. This reaction causes irritation and inflammation in the throat.

Some of the symptoms linked with EE are difficulty swallowing, typical GERD symptoms like heartburn, and food sticking in the esophagus. If traditional methods of GERD treatment have failed, you should ask your doctor about EE. Children may have abdominal pain, vomiting or regurgitation, difficulty swallowing, GERD-like symptoms, or an aversion to solid foods.

Right now, we have multiple ways to detect or diagnose EE. As mentioned, EE will not respond to the high-dose acid suppression therapy commonly used to treat GERD. A study of the pH level in the esophagus can also rule out reflux.

EE is best confirmed by an esophageal biopsy, a routine procedure that allows us to measure the eosinophil count in the esophageal tissue. Another way to detect EE is through an endoscopy, which uses a camera to search for the ring-like appearance of the esophagus associated with EE. But it is possible for patients with EE to have a normal endoscopy, so endoscopy with biopsy are key to the diagnosis.

Once EE is confirmed, we offer two treatment options. Topical steroids are usually an effective way to treat EE when used over the course of six to eight weeks. The second way is esophageal dilation. Esophageal dilation refers to the passage of small, specially designed rubber tubes (dilators) down the esophagus to stretch the narrowed esophagus.

At GIA, we are confident in our ability to identify EE and provide you with minimal risk treatment. Our team of specially trained physicians is equipped to give our patients the latest and most effective care available.