Medical Edge Newspaper Column

Acid Reflux and Cancer Risk

July 1, 2007
Dear Mayo Clinic:
I have had gastroesophageal reflux (GERD) for 12 years and have taken my anti-GERD medication faithfully. Now I've been diagnosed with Barrett's esophagus. Is there anything I can do to keep it from getting worse? Do I need surgery? -- Chicago, Ill.

Answer:
A small number of people with long-term gastroesophageal reflux disease, where stomach acid refluxes into the esophagus, develop Barrett's esophagus.

Acid reflux changes the cell structure in the esophagus. The normal lining of the esophagus looks like tile; the medical term is stratified squamous epithelium. In patients with Barrett's esophagus, the lining looks more like shag carpet. It's termed intestinal metaplasia with goblet cells.

Barrett's esophagus doesn't present unique symptoms, other than what patients typically experience with GERD: Heartburn, a burning pain or discomfort behind the breast bone in the chest; or acid regurgitation, a bitter or sour-tasting fluid coming up into the throat or mouth. Many patients (about 40 percent) with Barrett's esophagus do not perceive their gastroesophageal reflux at all.

The reason Barrett's esophagus matters is that patients with at least 3 centimeters of Barrett's esophagus lining have a 30- to 125-fold increased risk of esophageal cancer compared to the general population. Patients with shorter segments of Barrett's have a somewhat lower risk. Doctors treat patients with long- and short-segment Barrett's the same.

Although the cancer risk figures initially sound frightening, the overall risk of cancer in persons with Barrett's esophagus is low. Only 3 to 10 percent of persons with Barrett's esophagus will develop cancer in their lifetime. That means more than 90 percent will not get cancer.

Our best indicator of the seriousness of Barrett's esophagus is the degree of dysplasia found on a biopsy. Dysplasia is the Greek word for change. Higher grades of dysplasia indicate that the cells are more abnormal.

The symptoms of reflux (heartburn and acid regurgitation) can be controlled with medications, surgery and lifestyle changes. However, neither medicines nor surgery have been shown to lower the cancer risk in patients with Barrett's.

The usual lifestyle recommendations for controlling reflux symptoms apply to patients with Barrett's esophagus. Cut back on caffeine (coffee, tea, soda, chocolate), alcohol, tobacco, mint and fatty foods. It is best to avoid lying flat within four hours of finishing a meal. One should consider sleeping with the head of the bed elevated.

Beyond these lifestyle changes, there is a range of treatment options. Some are approved by the FDA and others are considered experimental. The best approach will depend on the patient's health and the degree of dysplasia.

Barrett's esophagus is a complex process. When we have a patient with a new diagnosis of Barrett's, the education session to cover options takes about 90 minutes. To ensure that you are doing everything possible to manage the condition, I'd recommend a full educational session with a physician well versed in this condition.

-- Yvonne Romero, M.D., Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.