Tums. Maalox. Mylanta. Rolaids. These and other over-the-counter remedies spell "relief" for many of the millions of Americans who regularly have heartburn.

However, common heartburn isn't always just an annoying condition that's quickly remedied by an over-the-counter antacid. It can also be symptomatic of gastroesophageal reflux disease (GERD), which is the chronic regurgitation of acid from your stomach into your lower esophagus. And, long-term GERD can sometimes lead to Barrett's esophagus, a condition in which the color and composition of the cells lining your lower esophagus change because of repeated exposure to stomach acid.

Barrett's esophagus is uncommon. Only a small percentage of people with GERD develop Barrett's esophagus. But once Barrett's esophagus is diagnosed, there's a greater risk of developing esophageal cancer, which often spreads from the esophagus to lymph nodes and to other organs. Although increased, the absolute risk of esophageal cancer for someone with Barrett's esophagus is small — less than 1 percent a year.

You can eliminate or reduce the frequency of stomach acids flowing up into the lower end of your esophagus — and your chance of developing Barrett's esophagus — by making lifestyle changes.

Barrett's esophagus itself isn't associated with specific symptoms. But, heartburn and acid reflux — the sensation of bad-tasting liquid that may enter your mouth from your throat — are common indicators of GERD. And having GERD can lead to Barrett's esophagus.

A telltale sign of Barrett's esophagus — which your doctor can notice with a lighted instrument — occurs when the color of the tissue lining the lower esophagus changes from its normal pink to a salmon color. This cellular process, called metaplasia, is caused by repeated and long-term exposure to stomach acid.

Other signs and symptoms that may suggest a complication of GERD or Barrett's esophagus, including the development of esophageal cancer, include:

• Trouble swallowing. Often, a narrowing of the esophagus (esophageal stricture) leads to difficulty swallowing (dysphagia).
• Bleeding. You may vomit red blood or blood that looks like coffee grounds, or your stools may be black, tarry or bloody.
• Weight loss and loss of appetite. You may experience an unexpected drop in weight.

Barrett's esophagus usually develops from gastroesophageal reflux disease (GERD). Heartburn and acid reflux are the most common symptoms of GERD and result from stomach contents washing into the esophagus.

The ring of muscle at the junction of the esophagus and stomach (sphincter) normally traps acid in your stomach by clamping shut. GERD usually results from a weakened sphincter, and it can be aggravated by a protrusion of the upper stomach through the diaphragm (hiatal hernia).

Left untreated, GERD can lead to more serious complications. Severe heartburn with inflamed esophageal tissue (esophagitis) can cause chest pain intense enough to resemble a heart attack. Other complications of GERD may include esophageal stricture, bleeding, Barrett's esophagus and esophageal cancer.

Chronic heartburn and acid reflux put you at risk of GERD and Barrett's esophagus because the esophagus is designed to carry food and liquid only one way: from your mouth to your stomach. The esophageal lining is sensitive to acid and unable to handle it. Your stomach, however, has a lining designed to withstand acid-containing stomach (gastric) contents.

Stomach acid is damaging to esophageal tissue. Repeated and long-term exposure to stomach acid can lead to the transformation of esophageal tissue into the salmon-colored tissue characteristic of Barrett's esophagus, which is actually an acid-resistant lining of cells similar to the cells lining your stomach.

Men are more likely to develop Barrett's esophagus than are women. White and Hispanic people are at greater risk of the disease than are blacks and Asians. Although Barrett's esophagus can affect people of all ages, the condition is most common in older adults.

See your doctor if you've had long-term trouble with heartburn and acid reflux. Talk to your doctor as soon as possible if you:

• Have difficulty swallowing
• Are vomiting red blood or blood that looks like coffee grounds
• Are passing black, tarry or bloody stools
• Experience an unexpected weight loss

Diagnosing Barrett's esophagus is difficult because it often doesn't exhibit specific symptoms. Experiencing the frequent and severe acid reflux of GERD may be the best indication that you either have Barrett's esophagus or may be at risk of the disease.

If you have severe acid reflux or have had acid reflux for many years, your doctor may discover Barrett's esophagus by examining your esophagus through endoscopy. Endoscopy involves inserting a lighted, flexible tube (endoscope) with a camera on its tip through your mouth and into your esophagus and stomach. Usually, you'll receive a local anesthetic, and you may be sedated for this procedure.

The procedure allows your doctor to search for abnormalities such as precancerous cell changes (dysplasia) or an abnormal junction between your stomach and esophagus. In a healthy esophagus, the stomach-esophagus mucosal junction is at the lower end of the esophagus. In Barrett's esophagus, this junction is displaced upward. If Barrett's esophagus is suspected, your doctor also looks for evidence of cancer.

During endoscopy, your doctor may remove tissue samples (biopsies) of potentially abnormal areas to be examined under a microscope. If specimens reveal intestinal goblet-shaped cells not usually seen in the esophagus, your doctor may make a diagnosis of Barrett's esophagus.

Following your diagnosis, your doctor will probably recommend endoscopies at regular intervals to screen for cell changes that could indicate progression to cancer. This usually means a repeat endoscopy one year after your diagnosis, followed by endoscopies every two to three years if no dysplasia is present. If a tissue sample shows dysplasia, you may need screenings at shorter intervals — in some cases, as often as every three to six months.

Having Barrett's esophagus increases your risk of developing esophageal cancer. The earlier that metaplasia — the telltale changing of the color of the tissue that lines the lower esophagus from its normal pink to a salmon color — is detected, the better.

Barrett's esophagus may develop precancerous changes (dysplasia) in grades ranging from none (no dysplasia), to mild but still significant changes (low-grade), to serious changes (high-grade), and finally to invasive cancer. When high-grade dysplasia is detected, cancer often is already present. Cancer can spread from the esophagus to nearby lymph nodes and to other parts of your body.

The primary goal of Barrett's esophagus treatment is to prevent the development of esophageal cancer. It's not too late to treat dysplasia in Barrett's esophagus if it hasn't yet advanced to cancer.

Treatment for Barrett's esophagus may start with controlling GERD by making a number of lifestyle changes and taking self-care steps. These actions include losing weight, avoiding foods that aggravate heartburn, stopping smoking if you smoke, taking antacids or stronger acid blocking medications, and elevating the head of your bed to prevent reflux during sleep.

People with severe GERD and Barrett's esophagus usually need aggressive treatment, which may include medications, other nonsurgical medical procedures or even surgery.

• Proton pump inhibitors (PPIs). These medications — such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix) and esomeprazole (Nexium) — block production of acid and relieve irritated tissue.
• H-2-receptor blockers. Doctors sometimes prescribe this class of drugs to treat GERD and Barrett's esophagus. They're less expensive, although weaker than PPIs. Prescription H-2-receptor blockers such as famotidine (Pepcid), cimetidine (Tagamet), nizatidine (Axid) and ranitidine (Zantac) are also available over-the-counter in doses less than prescription strength.

Although these medications often are quite effective for GERD, once Barrett's metaplasia is present these drugs won't reliably reverse the condition, and the risk of cancer remains even if your GERD symptoms go away with treatment.

Surgery
Anti-reflux surgery (laparoscopic Nissen fundoplication) offers an alternative to dependence on medication for GERD. The procedure tightens the sphincter by wrapping part of the stomach around the lower esophagus to prevent acid reflux. Laparoscopic surgery involves inserting special instruments through small incisions — less than an inch. The procedure leaves only tiny scars. You can expect to stay in the hospital for one or two days after this surgery. Although surgery can be effective for GERD, once Barrett's metaplasia is present surgery won't reliably reverse the condition, and the risk of cancer remains.

If you have esophageal cancer, or if you have Barrett's esophagus and high-grade dysplasia, your doctor may recommend you undergo a major surgical procedure in which the esophagus is removed completely and the stomach is pulled into the chest (esophagectomy). You may need to spend about two weeks recovering in the hospital after surgery. Although this treatment is effective, it is associated with significant health risks. Up to 50 percent of people who undergo esophagectomy experience at least one serious complication, including pneumonia, heart attack and infections at the surgical site.

The surgical treatment of people with high-grade dysplasia is controversial. Some experts believe that esophagectomy should be used as a measure to protect against cancer. Other experts believe that it's sufficient to schedule screening endoscopies every three to six months and perform an esophagectomy only if cancer develops. Doctors generally don't recommend surgery for people with declining health or for those who are too weak to withstand a major procedure.

Alternatives to medications and surgery
Removal (ablation) of dysplasia makes possible the reversal of Barrett's esophagus, and it may prevent esophageal cancer. Combined with PPIs, ablation may be appropriate especially if you're not a good candidate for an esophagectomy. Ablation procedures include:

• Photodynamic therapy (PDT). First, you'll be injected with a drug called porfimer sodium (Photofrin) that makes the Barrett's cells sensitive to light. Then, your doctor inserts a specialized light source into your esophagus. The light causes a reaction with the Photofrin that destroys Barrett's cells.
• Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.
• Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett's cells.
• Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.
• Endoscopic mucosal resection. Using an endoscope, your doctor injects a saline solution under the area of your esophagus that contains dysplasia. A blister forms under these abnormal cells, allowing your doctor to cut or suction the abnormal area away from the underlying tissue without damaging the rest of your esophagus. Your doctor may recommend following this procedure with photodynamic therapy.

The long-term effectiveness of ablation procedures in preventing cancer is still being studied.

You may eliminate or reduce the frequency of stomach acids flowing up into the lower end of your esophagus by making the following lifestyle changes:

• Control your weight. Being overweight is one of the strongest risk factors for heartburn. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
• Eat smaller, more frequent meals. Three meals a day, with small snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.
• Loosen your belt. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.
• Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.
• Avoid stooping or bending. Tying your shoes is OK. Bending over for hours to weed your garden isn't, especially soon after eating.
• Don't lie down after eating. Wait at least two to three hours after eating to lie down or go to bed.
• Raise the head of your bed. An elevation of 6 to 9 inches puts gravity to work for you. Or you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head alone by using pillows isn't a good alternative.
• Don't smoke. Smoking may increase stomach acid. The swallowing of air during smoking also may aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer.