What You Should Know About Heartburn and Esophageal Cancer

Rick Davis, P.A.-C, Goutham Rao, MD

You may have heard recent news reports about links between heartburn and cancer of the esophagus that may have caused you to question your treatment. A relatively small but significant number of Americans develop esophageal cancer each year. There were 14,500 cases last year, compared with more than 106,000 cases of colon cancer. Therefore, the vast majority of heartburn sufferers don’t need to be overly concerned.

Gastroesophageal reflux disease (or GERD) is a common, chronic condition in which there is irritation or inflammation of the esophagus (the food tube) due to acid and other stomach contents returning back or “refluxing” back into the esophagus. While not all heartburn sufferers have GERD, the most common symptom of GERD is heartburn. In certain people with a genetic predisposition, prolonged and repeated exposure to stomach contents can transform the lining of the esophagus near where it joins the stomach. This transformation is called Barrett’s esophagus. In a very small amount of cases, cells lining the esophagus in Barrett’s esophagus can become cancerous. Middle aged and older white men are at the highest risk of Barrett’s esophagus.

Ten to Twenty percent of the population has frequent heartburn symptoms [1]
	About 10 percent of them develop Barrett’s esophagus, a pre-cancerous condition
		Less than 1 percent of them will progress to cancer of the esophagus; mainly in middle-age white men [3]

This process may sound alarming. Keep in mind that only about 10% of people with GERD will develop Barrett’s esophagus. Of those with Barrett’s esophagus, only about 1 – 2% will develop esophageal cancer.

A recent study from the United Kingdom examined the treatment histories of people with and without esophageal cancer. The researchers found that patients treated with acid suppressive drugs such as histamine blockers (H-2 blocker) (e.g. Pepcid, Zantac) or proton pump inhibitors (PPIs) (like Prilosec OTC), for GERD symptoms, inflammation of the esophagus, or Barrett’s esophagus were more likely to have cancer than those treated with the same drugs for other gastric or intestinal problems. This doesn’t mean that acid suppressive drugs increase the risk of esophageal cancer. The researchers concluded that the underlying condition (e.g. GERD or Barrett’s) is the actual risk for cancer, not the medications being used, which have proven safe and effective for many years.

Chronic heartburn treatments such as H2-blockers or PPIs have been the mainstay of treatment for chronic GERD and Barrett’s esophagus. These drugs have an excellent safety record, and some are now available without a prescription. These medications improve symptoms, heal inflammation and may prevent Barrett’s lining from getting worse. However, it is not known if these treatments actually prevent cancer from occurring in people with Barrett’s esophagus. This is why it is so important for patients with this pre-cancerous condition to have periodic screenings to spot any changes early.

There is no question that more people are developing esophageal cancer today than several years ago. For now, the reasons are unknown. Although media reports have speculated about the connection between heartburn treatments and cancer, scientific research shows that PPIs may actually slow the growth of cancers, as might other types of medications including aspirin.

Summary:

Keep in mind the following key points:

Esophageal cancer is rare. Only a small number of heartburn sufferers will develop Barrett’s esophagus, the condition that leads to cancer.
You should seek treatment for heartburn and other symptoms of GERD to improve your quality of life.
You and your doctor can discuss the types of treatments that are best for you depending upon the frequency and severity of your symptoms. Your doctor can also provide advice about your risk for esophageal cancer.

References:

Dent J et al. Epidemiology of gastro-esophageal reflux disease: a systematic review. Gut 2005;54:710-17.
Vakil N et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101:1900-20.
Holmes RS and Vaughan TL. Epidemiology and pathogenesis of esophageal cancer. Semin Radiat Oncol. 2007; 17:2-9.
Garcia Rodriguez LA, et al. Gastric acid suppression and risk of esophageal and gastric adenocarcinoma: a nested case control study in the UK. Gut 2006;55:1538-44.
American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga.