Dear Dr. Roach: Is it true that someone who takes antacids every day is more likely to get cancer of the esophagus?
D.R.
Yes, people who take antacids frequently are more likely to be diagnosed with esophageal and stomach cancer. However, people who take more antacids usually do so because they have reflux. Reflux predisposes one to Barrett’s esophagus, which predisposes one to cancer. This is a more reasonable explanation than that taking antacids causes cancer. Although some authorities have postulated that antacids may allow bile to reflux into the lower esophagus, increasing cancer risk, I believe the primary issue is that people take antacids too long before seeking medical attention when there might be something seriously wrong.
With either possibility, the message is clear: Don’t take antacids for prolonged periods without seeing your doctor. Those symptoms might be more serious than you think.
Dear Dr. Roach: Last year, my 86-year-old mother was diagnosed with a rare disease, hemophagocytic lymphohistiocytosis (HLH). It took some time and a hospital stay before this life-threatening condition was diagnosed. Thankfully, she responded to chemotherapy and high doses of steroids and is now getting back to normal. What are the chances of this terrible disease reoccurring?
Anon.
Hemophagocytic lymphohistiocytosis is a rare and aggressive disease of the immune system, with excess inflammation leading to tissue damage and, potentially, organ failure. It typically affects the liver and might affect the brain and lungs. Blood tests show abnormalities in liver function and the ferritin level is exceedingly high, which usually suggests hemochromocytosis, a problem of iron overload. This can lead to confusion about the diagnosis. Diagnosis is made after careful evaluation of all the relevant lab findings and, usually, a bone marrow biopsy and spinal tap. Genetic testing for HLH mutations can help confirm the diagnosis.
Even though HLH is not a cancer, it is treated most of the time with aggressive chemotherapy and steroids, as your mother’s was. Unfortunately, it has a cure rate less than that of some leukemias, with which it may be confused. If people do relapse, they usually relapse within a year. People with the genetic mutation have a higher risk of relapse. So your mother is looking good for not relapsing, once she makes it to a year.
There is much more information about this complex disease at a support-group website at hlhsupport.org.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
