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, you may have a higher risk of developing cancer of the esophagus and larynx (voicebox). These cancers are fairly rare, and reflux is common. If your reflux has been severe or long-lasting, it may be worth having a screening test.
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. Barrett's esophagus occurs in a small fraction of people who have chronic reflux. While this condition itself is not cancerous, it is associated with a 50-fold increase in the risk of developing esophageal cancer. Many doctors recommend a one-time screening test to check for Barrett's in people who have had frequent heartburn symptoms over an extended period of time (usually, for five years), or who have needed long-term treatment with an anti-acid medicine. If you are found to have Barrett's esophagus on your initial screening, you should have regular endoscopy and biopsies to look for cancer.
But even without Barrett's esophagus, people with GERD are at marginally 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 does GERD lead to Barrett's changes, and potentially to cancer? 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. When cells are changing, they are vulnerable to becoming cancerous.
Only a very small fraction of people with reflux will get esophageal cancer. Treatment to reduce reflux symptoms limits irritation of the esophagus by the stomach acid. Treatment with anti-acid medicines has been linked with reversal of Barrett's changes, in some patients. Most experts recommend lifelong anti-acid treatment for people who have Barrett's esophagus, because it may lower the cancer risk.
Take Home Message: Take Heartburn Seriously
- 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. 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.
- 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.