• Are heartburn drugs safe to use indefinitely? Heartburn drugs aren't specifically approved for long-term use, but many doctors encourage patients to use them indefinitely.

The most effective drugs, proton pump inhibitors such as AstraZeneca's prescription Nexium or Procter & Gamble's over-the-counter Prilosec, have been in use for almost 20 years and are considered safe. Questions remain about whether the drugs, which suppress acid production, cause changes in the gastric environment that might increase cancer risk. But far more is known about the damaging role that acid plays. So many doctors still advise using the drugs for now. "We need to treat heartburn well and with whatever the best method is, and currently that is PPIs," says Scott Swanson, chief of thoracic surgery at Mount Sinai School of Medicine in New York. "But we need to follow those patients closely."

Patients who are concerned about long-term use of drugs should talk to their doctor about additional monitoring. One method is ambulatory pH monitoring in which a probe is placed in the esophagus to record acid levels over 24 hours. Although not widely used, it can help determine whether acid-suppressing drugs are working to control reflux or just masking symptoms.

• Is surgery an option? Antireflux surgery to tighten faulty valves or repair hernias at the base of the esophagus can also stop chronic reflux by helping prevent stomach acids from sloshing upward into the esophagus. Symptoms can return over time, however, and nobody really knows whether the drugs or surgery can slow the progression of Barrett's or prevent the onset of esophageal cancer. Other new procedures burn off the esophageal lining, but those methods are new and unproven.

• Are there nondrug treatments? Some patients can manage GERD without drugs. Elevating the head of the patient's bed by about four inches — say, by placing blocks of wood under the legs — can help. The method uses gravity to keep acids down in the stomach while sleeping. Cut back on chocolate, spicy foods, tomato sauce, orange juice, peppermint, onions, soft drinks and other foods linked with heartburn. Avoid processed meats, which contain nitrates that may pose a higher cancer risk in GERD sufferers and those using acid-suppressing medications.

Most important, eliminate fatty foods, which slow the rate that the stomach empties. Fatty foods also trigger a chemical change that relaxes the stomach valve, allowing acid to surge up into the esophagus. Being overweight puts extra pressure on the abdomen and may cause the esophageal valve to loosen.

Some early studies have shown that daily aspirin use may cut the risk of esophageal cancer, and studies are under way looking at whether the anti-inflammatory drugs known as Cox II inhibitors, like Celebrex, may also help treat Barrett's. Other studies have shown that regular consumption of green tea may lower risk for esophageal cancer, but data are far from conclusive.