April is esophageal cancer awareness month and I was stimulated by two patients I saw recently to highlight the association of esophageal cancer with chronic GERD (heartburn, acid reflux) and the over the counter treatments people take for GERD.
The first patient had experienced acid reflux for over 25 years. Magically his acid reflux got better a couple of years ago. But, then he began to have trouble with his food holding up every time he swallowed. After discussing this with his primary care physician, he was referred for an endoscopy that unfortunately showed he had developed a cancer of the esophagus.
The second patient came to see me at the urging of a friend. He had 15 years of GERD symptoms and wanted to discuss whether surgery would help his reflux symptoms. He was taking over-the-counter Prilosec as well as Tums and Maalox. He slept in a chair because the reflux at night was terrible when he lay down. He had not spoken to his primary care physician about his problem because it didn’t seem that important yet he had changed his life dramatically to avoid having symptoms of acid reflux. His evaluation showed that his reflux was severe enough that the normal lining of the esophagus was “burned” and had been “replaced” with Barrett’s Esophagus. The Barrett’s was a marker for the severity of his reflux but it is also a pre cancerous condition that could lead to the development of esophageal cancer. It’s not hard to imagine that if he hadn’t heeded the urgings of his friend, he may in the same position as patient #1 10 years from now.
There are two types of esophageal cancer: squamous cell (smoking and alcohol related) and adenocarcinoma (GERD related). In the United States adenocarcinoma is the most common because GERD is so common in the population. This type of esophageal cancer is the increasing rapidly and the number of new cancers diagnosed has grown by 600 % since 1970. The biggest risk factor for esophageal adenocarcinoma is chronic acid reflux or GERD.
Why am I writing about this? To highlight three common issues I hear everyday:
• GERD and esophageal cancer are related – GERD is very common but not everyone will develop cancer. However, you may be at risk if you suffer from significant symptoms of GERD more than 3 times per week and have experienced it for great than 10 years
• Discussing GERD with your physician - It is important if you are treating your GERD with over-the-counter medications to discuss this fact with a physician.
• Evaluation of GERD – There is no right answer to this question, but in general, evaluation should be considered if you have had GERD for over 10 years, your symptoms of GERD do not respond or continue after taking the medication, your symptoms worsen or magically disappear or if you are having trouble swallowing food.