Got Heartburn???

Posted: Nov. 2, 2009

Got Heartburn???

Gralton Family Gift Supports Medical College of Wisconsin

Study of Heartburn, Reflux and the Esophageal Cancer Link

 

A $1.1 million dollar gift from the Daniel and Laura Gruber Charitable Lead Trust #3 will boost the study of esophageal cancer at The Medical College of Wisconsin in Milwaukee by establishing the James J. Gralton Laboratory and the James J. Gralton Endowed Research Fund. This gift is a tribute to the late James J. Gralton, father of Laura Gralton and son-in-law of Daniel & Laura Gruber, who passed away from esophageal cancer at the age of 50 in October of 1998. The late Mr. Gralton had retired as president of Milwaukee Seasoning Laboratories and later founded Hovercraft America. Ms. Gralton shared that she “hopes that these funds will help research and identify the triggers and early symptoms of this nasty disease”.

Reza Shaker, M.D. and his colleagues are studying the genetic reasons why chronic gastroesophageal reflux disease – or chronic heartburn – can lead to cancer of the esophagus. This donation will afford Dr. Shaker with the necessary resources to further his research. The endowed portion of this gift will provide a continued revenue stream for this research.

Dr. Shaker is the Joseph T. Geenen Professor and Chief of the Division of Gastroenterology and Hepatology, and director of the Medical College’s Digestive Diseases Center. He is also senior associate dean for the Clinical And Translational Science Institute. Dr Shaker practices at Froedtert Hospital and the VA Medical Center –Milwaukee, major teaching hospitals of the Medical College.

“We are deeply grateful to Laura Gralton on behalf of her late grandparents, Daniel & Laura Gruber, for supporting this line of research. This generous gift, given in these tough economic times, is a significant testament to the commitment that this family has towards improving the odds for people diagnosed with esophageal cancer and will help us accelerate the understanding of this very common and vexing problem,” says T. Michael Bolger, president and CEO of the Medical College.

“My dad was one of those people that everyone enjoyed immediately upon knowing him. To have lost him so early, as well as to a disease that we know so little about has been devastating. It is my hope that with this gift, Dr. Shaker and his colleagues will more closely be able to identify the triggers and solutions of this nasty disease,” said Gralton.

The gift, given over a six-year period, will let Dr. Shaker and his associates pioneer the heretofore never systematically examined genetics behind this problem. His work may lead to the prediction of who is likely to develop serious esophageal problems that could lead to cancer.

The American Cancer Society says that over 16,470 people – 12,940 men and 3,530 women – nationally are expected to develop cancer of the esophagus each year.

While most people experience the discomfort of heartburn once in a while, for between seven and 10 percent of the population it occurs every day. The researchers want to know why in half of the people with reflux this frequent back-up or reflux of stomach content damages the esophageal lining and can produce ulcers. Of this group, 20 percent go on to develop Barrett’s esophagus, in which squamous cells (flat cells on the esophagus’ surface) are changed into columnar (tall) cells that can become cancerous. One percent of these patients develop cancer.

“The question is what is the genetic basis for these different responses to reflux injury,” asks Dr. Shaker. Dr. Shaker is looking for answers at the molecular genetic level to see how the esophagus defends itself against acid injury ranging from esophagitis, to Barrett’s to cancer

“We are studying cells in the esophageal lining in three groups of patients to “characterize the differences in their genetic expressions.” The three groups, each with about 20 patients, are those with symptoms of heartburn but whose cells are not damaged, those with symptoms and cell damage that is not that of Barrett’s esophagus, and the third will be patients with Barrett’s.

“We need to broaden our approach. Merely concentrating on Barrett’s and the damaged area is probably not enough. We need to look at the whole organ, the esophagus, and see what the difference is between the three groups. This may give us some clue as to who is going to be at risk and who is not,” he says.

The study to date has identified injury and repair pathways that may play a role in these transformations. “This finding could lead to new information useful for devising predictive markers and possibly treatments that are more innovative than existing ones,” says Dr. Shaker.

This project is but one of many that Dr. Shaker and his colleagues are involved in concerning digestive diseases. They are studying the way the body's physiology is altered in reflux disease or chronic heartburn and trying to understand the body's protective mechanisms against airway complications of reflux. Among the topics they are studying is how the esophagus communicates with the brain to register injurious events. Over and under reporting can cause problems such as chest pain that feels like a heart attack but is coming from the esophagus and not the heart, or not perceiving the burning sensation in response to prolonged acid reflux.

“If you feel heartburn, you can do something about it. If you don’t feel it you can end up with a damaged esophagus, maybe cancer. Sensation is very important, so we are looking at the sensory physiology of the esophagus at the nerve and at the brain level,” he says.