News Perspectives

GERD and Cancer

More cases of a rare cancer may be associated with gastroesophageal reflux disease (GERD) than doctors previously believed, says a study in the June issue of the Archives of Surgery. According to the journal's press release, GERD may increase the risk of all tumors found at the far end of the esophagus, where it meets the stomach. In the past, researchers thought only some of these tumors could be linked with GERD, which causes stomach acids to flow backward into the esophagus.

Study Examines Characteristics
of Cancers of the Esophagus

What is the Doctor’s Reaction?

It is common for acidic digestive juices to reflux (flow backwards into the esophagus) during burps or between swallows. Acid reflux symptoms such as heartburn, regurgitation of food or a sour taste are experienced by more than four out of ten Americans on a monthly basis, and by almost one out of five on a weekly basis. The symptom is no worse now and no more common now than it was ten years ago, but more Americans are fearful about it today. Publicity has made it clear that reflux can increase your risk for a rare cancer, cancer in the esophagus. Seeing some of the dramatic television advertisements by anti-acid drug makers that allude to cancer risk, it is no wonder that acid medicines are blockbuster drugs.

Acid reflux can cause irritation and inflammation in the esophagus, and it can lead to a changed type of lining in the lower esophagus named “Barrett’s esophagus.” Barrett’s esophagus is a sign that your esophagus has gone through a repairing process. In the repair process, the esophagus slightly adjusts its tissue type. If you have Barrett’s esophagus, you also have a somewhat greater chance of developing a cancer in your esophagus.

Some experts recommend that you be checked for Barrett’s changes in your esophagus, if you have had obvious reflux symptoms for more than a few years.

Should esophageal cancer be a genuine worry for you if you have frequent symptoms of reflux? As a primary care doctor for adults, It is not worth very much of your attention. Esophageal cancer is diagnosed in only 6500 people in the United States each year. That is approximately the same number of people who are struck by lightning annually in the U.S.

What Changes Can I Make Now?

Gastroesophageal reflux is common, but esophageal cancer is not. You should keep this in perspective when you review any advertisement for anti-acid medicines, so that you don’t worry more than is warranted.

Anti-acid medicines provide wonderful relief for most people who use them to treat heartburn associated with acid reflux. No one knows for sure whether anti-acid medicines prevent esophageal cancer. But some experts think they might help, and the prospect of cancer is frightening. Is there any harm in using these drugs just in case they have a benefit? Unfortunately, there is a possible harm. The acid in your stomach is one of our natural defenses against bacteria. People who take anti-acid medicines are somewhat more likely to develop pneumonia, relative to people who do not use an antacid.

I recommend that you treat your acid reflux symptoms with medication if you are bothered by the symptom of heartburn, if you have hoarseness or worsened asthma due to your reflux, or if you have any history of bleeding from your esophagus. If you have already been found to have Barrett’s esophagus, it may also be reasonable to use daily medicine even if your symptoms are not severe. However, it has not been proven that these medicines prevent cancer even in people with Barrett’s changes. For a subgroup of people who have a particularly worrisome pattern of Barrett’s, frequently repeated inspections by endoscopy and removal of suspicious areas by surgery appears to decrease the chance that a serious cancer will develop.

Should you have an endoscopy (camera inspection in the esophagus) to check for Barrett’s esophagus? The American Gastrointestinal Association recommends that you have an endoscopy once, if you have had “long-term” reflux symptoms. If Barrett’s changes have not appeared during the first five years, they are not likely to appear later. However, we side with other experts who feel that the endoscopy procedure should be reserved for people who have other worrisome symptoms (see below). There is a high enough chance that you could have a complication from the procedure that it is worth avoiding it until there is good evidence that it can meaningfully reduce your risk of getting and surviving a cancer.

With or without long-term reflux symptoms, you should have an endoscopy if your doctor discovers a low blood count (anemia) on an occasion when you have blood tests, or if you have any of these symptoms:

• Difficulty swallowing
• Pain during swallowing
• Vomiting blood
• Weight loss

What Can I Expect in the Future?

If it were known which patients with reflux were the most likely to develop Barrett’s esophagus changes, then it would be far more practical to use endoscopy as a screening tool for cancer of the esophagus. Experts are investigating gene patterns in people who have Barrett’s changes, and they believe that a gene pattern may be one thing that promotes this change. It is very likely that in future years, it will be possible to use a blood test (in this case, a genetic test) to know which people with acid reflux are at highest risk for this rare cancer. People with concerning genes could then be watched closely and treated quickly.