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Cancer Concerns About Heartburn Acid reflux may be doing more damage than you think. For many of the approximately 17 million Americans who have it, heartburn (gastroesophageal reflux disease, or GERD) is an annoying but relatively harmless problem usually handled with over-the-counter products such as antacids or acid blockers. As more and more medications for treating heartburn become available, many people treat themselves without ever seeing a physician. But if you have frequent or persistent heartburn, seeing a doctor may help you get better treatment, especially because people who have more persistent and severe cases of heartburn may carry a higher risk of developing cancer of the esophagus and larynx (voicebox). Having persistent or regularly recurring heartburn symptoms is associated with a condition called Barrett's esophagus, in which ongoing exposure to acid is thought to change the type of cells lining the esophagus. While this condition itself is not cancerous, it is associated with a 50-fold increase in the risk of developing esophageal cancer. People with Barrett's esophagus should have regular endoscopy and biopsies to look for cancer. Doctors are more likely to use endoscopy to look for Barrett's esophagus when a person has frequent heartburn symptoms over an extended period of time. But even without Barrett's esophagus, people with GERD are at higher risk of cancer of the esophagus and possibly the larynx. Some of the increased risk may be related to the fact that many GERD patients smoke cigarettes and/or drink alcohol, both habits that greatly increase the risk of these cancers. There is also some reseacrh indicating that GERD alone can increase the risk of cancer. How heartburn — a symptom of GERD — leads to cancer isn't well understood. With GERD, the sphincter muscle that separates the base of the esophagus from the stomach relaxes inappropriately or loses its tone. This allows stomach contents and bile to flow, or reflux, up into the esophagus, where acid in the refluxed material can cause irritation. Sometimes, the acid can reach the larynx and cause reflux laryngitis, or inflammation of the larynx. Physicians believe that, over time, this irritation leads to chronic inflammation, which in turn may result in abnormal changes in the cells lining the esophagus. Only a small fraction of people with reflux will get esophageal cancer, but anything that can cause a substantial increase in risk shouldn't be ignored. While there is no proof that treating heartburn reduces the risk of cancer, it does seem that people who have more severe, frequent symptoms for longer periods of time have a higher cancer risk. Treatment to reduce reflux symptoms limits irritation of the esophagus by the stomach acid and may lower the cancer risk. Take Home Message: Take Heartburn Seriously If you suffer from heartburn at least once a week, especially if your heartburn is severe or prolonged, the best advice is to see your physician. Based on your symptoms and physical examination, your doctor may suggest: - Diet changes. Caffeine and fatty foods can encourage the relaxation of the sphincter, making heartburn more likely to occur. Other foods that can make heartburn worse include alcohol, spicy foods, peppermint, citrus fruits and tomatoes, so your doctor may recommend that you avoid or limit them.
- Lifestyle changes. Being overweight, smoking and snacking before bed all contribute to heartburn. Excess weight in your abdomen presses against the stomach, crowding it and making food more likely to flow into the esophagus. Smoking causes the esophageal sphincter to relax. Heartburn can be relieved in some people simply by changing these lifestyle factors and diet.
- Medication changes. Some medications, including certain blood pressure drugs and some antidepressants, may promote reflux by relaxing the sphincter. Your doctor may suggest alternate medications.
- Additional medication. Over-the-counter medications such as Tagamet, Zantac and Prilosec OTC treat heartburn symptoms by reducing acid production. If you are still having symptoms on these medications, your doctor can help by prescribing higher doses of these medications or stronger drugs available by prescription only.
- Endoscopy. The only way doctors can know how much, if any, damage has been caused by acid reflux is to examine your esophagus with a long, flexible lighted tube called an endoscope, which is placed down your throat into the esophagus and stomach. If there are signs of Barrett's esophagus, you'll probably be asked to repeat the test in one to two years. If necessary, a biopsy can be done during the endoscopy to test for cancerous cells in the esophageal lining.
Last updated June 29, 2005
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