Getting Serious This Esophageal Cancer Awareness Month

Many times people shrug off ongoing acid reflux and think it’s no big deal. Depending on the intensity of their symptoms, it may become an acceptable way of life. However, GERD (Gastroesophageal Reflux Disease) can have some devastating consequences if left unchecked. But there’s good news for those who take their acid reflux seriously.

With April being Esophageal Cancer Awareness Month, it’s time to talk about the long-term health complications that can arise when stomach acid repeatedly washes into your esophagus. Over time, the exposure can change the lining of the esophagus as normal cells are replaced with tougher, more acid-resistant cells, like the ones found in your stomach and intestines. This creates a condition known as Barrett’s esophagus (named for the thoracic surgeon who first described the condition in 1950).

Interestingly, as these new acid-immune cells increase, GERD sufferers may have less heartburn and other tell-tale symptoms and think that their reflux is resolving. However, according to Dr. Bruce D. Greenwald, chairman of the board of the Esophageal Cancer Action Network. “Acid still refluxes but the lining doesn’t have the same sensors as a normal lining.”

The greatest concern with Barrett’s Esophagus is that this new environment is more vulnerable to serious disease and the risk of developing esophageal cancer increases 30 – 125 fold. With reflux induced cancer taking the lead as the fastest growing cancer in America, it’s worth knowing what preventative measures you can take.

How do you know if you have Barrett’s esophagus?

The only way to determine any changes in your esophagus is to have an upper endoscopy. Under mild to moderate sedation, a small, flexible tube is gently inserted down your throat, into the esophagus and down to the stomach, so the esophageal lining can be examined. While the benefits of your doctor seeing inside your esophagus greatly exceeds any discomfort (minimal to none with the proper sedation), you may need to be your own advocate when it comes to having this important, diagnostic test.

In December, 2012, the American College of Physicians (ACP) released guidelines on the use of upper endoscopy for reflux disease. While the goal was to limit unnecessary procedures, headlines in the media like, “Most Heartburn Patients Can Skip Upper Endoscopy, Guidelines Say” sent a confusing message to those who didn’t read further into the article. And the misunderstanding could come at the highest cost. The harsh truth is that esophageal cancer is usually realized at a late stage when little can be done to help or reverse the situation. According to an article published on RefluxMD, titled “Let’s Change the Headlines on Reflux Disease”:

“The most incredible statistic about reflux-induced cancer is that more than 85% of patients who develop it never had a prior endoscopy. As a result, this cancer is usually discovered at an advanced stage. The opportunity to diagnose Barrett’s esophagus, the premalignant condition preceding cancer, to detect cancer early and prevent death, was missed in these people.

The challenge is to decide the appropriate time for an endoscopy in a person who has GERD. We agree that endoscopy is less urgent for people in the early stages of the disease, but believe the coverage of the ACP guidelines misses a critical point: endoscopic diagnosis can be life saving when done appropriately.”

And remember, if the lining of the esophagus has changed as a result of long-term reflux, then symptoms may not even be present. More than 40 percent of those who develop Barrett’s esophagus report no signs of reflux, which may also account for silent reflux sufferers that have no heartburn (but may experience night wakings, a chronic cough and/or hoarseness).

While Barrett’s esophagus and esophageal cancer are serious matters, the good news is that you can have a real impact on long-term affects of reflux with the following strategies:

1. Make lifestyle changes even if you’re using other treatments, like medication:

• avoid trigger foods (The known culprits are citrus fruits, onions, garlic, tomato-based products, spicy and fatty foods, fried foods, chocolate, peppermint and caffeinated and alcoholic beverages – some of these foods may not bother you while other foods not listed here may cause a reaction. It’s trial and error to finding which foods trouble you the most.)
• lose weight if needed (even a few pounds can make a difference)
• eat smaller meals
• avoid tight-fitting clothing
• wait a couple hours after eating before lying down
• sleep on an incline system that keeps you on your side as nighttime reflux is the most damaging (see a previous post “The Truth About Nighttime GERD: Don’t Let It Keep You Up” for more information)

2. Know when to talk to your doctor.

The Esophageal Cancer Action Network (ECAN) has put together a useful guide for patients that’s been reviewed and endorsed by many doctors. Their brochure provides straight forward advice on how to advocate for your own healthcare, including when to talk to your doctor about reflux and/or Barrett’s Esophagus:

• when you have more than occasional heartburn symptoms
• when you have experienced heartburn in the past, but symptoms have gone away
• when you have any pain or difficulty swallowing
• when you have a family history of Barrett’s Esophagus or Esophageal Cancer
• when you have an ongoing, unexplained cough
• when you have been speaking with a hoarse voice over several weeks
• when you have a long lasting, unexplained sore throat
• when you cough or choke when you lie down

If you are serious about addressing ongoing acid reflux/GERD, than you can seriously influence your future health. Make a big deal of lifestyle changes that will improve your reflux and check-in with your doctor if you have any of the concerns mentioned above. You can help change the outlook on esophageal cancer.

References:

1. Esophageal Cancer Action Network (ECAN). “The Link Between Heartburn and Cancer." April 12, 2013.

2. Laura Cox, Dr. William Dengler, Dr. Para Chandrasoma, and Dr. Tom DeMeester. “Let’s Change the Headlines on Reflux Disease”. January 29, 2013.

3. Ryan Jaslow. “Most Heartburn Patients Can Skip Upper Endoscopy, Guidelines Say.” CBS News. Read More Deceber 4, 2012.

4. Catherine Winters. “The GERD-Cancer Connection”. Spry Living. Read More April 11, 2013.