I have been diagnosed with Barrett's esophagus and my doctor has been trying different medications without much luck. Recently, he put me on Protonix. Can you tell me more about this medication and its effects?

R.

Barrett's esophagus is one of the potential complications of gastroesophageal reflux disease (GERD). In this condition, chronic acid reflux causes changes in the cells that line the lower esophagus. Instead of looking like esophageal cells, the cells appear identical to those that line the small intestine. People with Barrett's esophagus face a 30 times greater risk of developing esophageal cancer than other people.

So, once a patient is diagnosed with Barrett's esophagus, doctors usually perform multiple biopsies (tissue samplings) to check for signs of esophageal cancer. If the biopsies find a cell abnormality known as severe dysplasia, there is a more than 40 percent chance that the patient will eventually develop esophageal cancer.

Various therapies, including high-dose acid-suppressing drugs and anti-reflux surgical procedures, have been tried to halt the progression of Barrett's to cancer. None has proven effective in reversing Barrett's or in preventing the development of cancer.

Still, it is recommended that GERD patients who have Barrett's be treated with one of the proton-pump inhibitor (PPI) drugs -- the most potent acid-suppressive medications available. The newest agent in this category is rabeprazole (Protonix). In studies done so far, it appears that this drug is as effective at preventing stomach-acid production as other medications in the PPI class (Prilosec, Prevacid, Aciphex). However, it must be emphasized that there is no evidence that Protonix (or any other PPI) will lead to regression of the Barrett's, so it is extremely important for you to follow up with your gastroenterologist for periodic biopsies.