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What you need to know about heartburn, Barrett’s esophagus and cancer risk

GERD
Persistent heartburn may lead to Barrett's esophagus, a condition that may increase the risk of esophageal cancer.

Many people experience heartburn or acid reflux from time to time. However, those who struggle to find relief from frequent heartburn may have developed gastroesophageal reflux disease (GERD), a chronic condition that develops when stomach acid and other digestive substances bubble up from the stomach into the lower esophagus.

If you experience GERD twice a week or more, you may consider consulting your doctor to determine if you have developed Barrett’s esophagus, a condition that may require monitoring and treatment and may lead to an increased risk of esophageal cancer. In fact, according to the National Institutes of Health, up to 15 percent of people with gastroesophageal reflux disease (GERD) will develop Barrett’s esophagus.

What is Barrett’s esophagus?

Barrett’s esophagus occurs when abnormal cells or pre-cancerous tissue grow in the lining of the esophagus, leading to uncomfortable, heartburn-like symptoms in some people. Approximately 5 percent of Americans suffer from Barrett’s esophagus. Men are twice as likely as women to develop the condition. 

“The biggest reason people living with this condition should seek treatment is to confirm that there is no precancerous cells and also to consider eradication procedures in selected patients that can reduce the chances for developing esophageal cancer,” says Pankaj Vashi, MD, Gastroenterologist and Vice Chief of Staff at Cancer Treatment Centers of America® (CTCA), Chicago.

Risk factors and symptoms

While some people at high risk of Barrett’s esophagus may not notice symptoms, most people with the condition struggle with one or more of the following:

  • Heartburn
  • Regurgitation (sensation of burping acid into the throat)
  • Chest pain
  • Difficulty swallowing (especially solid foods)
  • Persistent dry cough
  • Persistent hoarseness

These symptoms combined with other known risk factors, may increase your likelihood of developing Barrett’s esophagus, including:

  • GERD, or persistent heartburn, acid reflux and/or regurgitation
  • Obesity
  • Age
  • Ethnicity (more common among Caucasians)
  • Sex (more common in men)
  • History of smoking

“Screening allows us, through an endoscopic procedure, the ability to see the patient’s esophagus to determine whether or not there is damage to the lining or the presence of pre-cancerous cells,” Dr. Vashi says. “If we find no evidence of disease or damage, we often suggest the use of a proton pump inhibitor to manage the reflux, in conjunction with lifestyle adjustments and follow-up endoscopic procedures every two to three years.

Learn more about proton pump inhibitors and cancer risk.

Treating Barrett’s esophagus

Treatment options for Barrett’s esophagus may vary, but they include:

Radiofrequency Ablation (RFA): This technique delivers radiofrequency energy directly to the esophageal mucosa, resulting in lower rates of esophageal cancer when treated. The American Gastroenterology Association and the American Society for Gastrointestinal Endoscopy recommend RFA as a safe method for treating some cases of Barrett’s esophagus.

Cryotherapy: This technique destroys esophageal mucosa by freezing with liquid nitrogen. During cryotherapy, a catheter is inserted through the endoscope to treat the affected tissue.

Endoscopic Mucosal Resection (EMR): This is a targeted technique to remove superficial/mucosal tissue. During EMR, tissue samples are acquired, allowing the pathologist to examine the cells to confirm and stage the diagnosis.

Surgery: In severe cases, in which the esophagus does not respond to eradication procedures, your doctor may recommend surgically removing the Barrett’s mucosa and part of the esophagus.

Dr. Vashi recalls an obese patient who developed Barrett’s esophagus after suffering longstanding acid reflux. The patient tried lifestyle changes and treatment procedures, but tests continued to identify pre-cancerous cells in her esophagus.

“Eventually, in spite of being a high-risk patient due to obesity, she underwent the surgical removal of part of her esophagus,” he says. “Catching this early and performing surgery may have prevented her from developing advanced cancer of the esophagus. The surgery, along with dietary interventions, also resulted in significant weight loss, which, in turn, may prevent her from developing other comorbid conditions in the future.”

Lifestyle changes

For patients with Barrett’s esophagus, the risk of developing esophageal cancer may be reduced not only by early treatment measures, but also making sure they make major lifestyle changes after treatments, Dr. Vashi says.

Simple lifestyle strategies that may help reduce symptoms of GERD include:

Staying upright: Elevate the head of the bed to reduce reflux symptoms at night. Also, don’t lie down for a post-meal nap. Stay upright after eating to help with digestion.

Losing weight: Excess weight puts pressure on your stomach and relaxes the lower esophageal sphincter (LES) muscle, which regulates food moving from the mouth to the stomach, contributing to reflux.

Quitting tobacco: Smoking and secondhand smoke may damage tissue in the throat, the LES and mucus membranes and may trigger the stomach to produce more acid.

Dressing comfortably: Wearing loose-fitting clothing around your waist may help reduce symptoms.

Changing your diet: Dietary changes are important to manage the symptoms of reflux. Common food triggers include:

  • Acidic foods
  • Fatty, spicy and fried foods
  • Foods that loosen or relax the LES, such as caffeine, chocolate, alcoholic beverages, mint, onions and garlic

Learn more about risk factors, symptoms and treatments for esophageal cancer.