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How Is Chronic Heartburn Associated With Esophageal Cancer

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Heartburn Raises Odds For Esophageal Larynx Cancers

Heartburn Reflux and GERD: Preventing the Progression to Esophageal Cancer

HealthDay Reporter

MONDAY, Feb. 22, 2021 — People with chronic heartburn may face increased risks of several rare types of cancer, a large U.S. government study shows.

Researchers found that among more than 490,000 Americans aged 50 and up, those with gastroesophageal reflux disease had about twice the risk of developing cancers of the esophagus or larynx .

GERD, or acid reflux, occurs when stomach acids chronically escape into the esophagus, which is the muscular tube connecting the throat and the stomach. The most common symptom is heartburn.

The condition is exceedingly common, affecting an estimated 20% of Americans, according to the U.S. National Institutes of Health .

GERD has long been established as a risk factor for esophageal adenocarcinoma, which, in the United States, is the most common type of tumor arising in the esophagus.

The new study, published Feb. 22 in the journal Cancer, links GERD to a second type of esophageal cancer — called squamous cell carcinoma — as well as laryngeal cancer, which arises in the voice box.

Experts stressed that the absolute risk is low: The vast majority of people with GERD will never develop the cancers, all of which are fairly rare.

“Our findings should not alarm people diagnosed with GERD,” said Christian Abnet, a researcher with the U.S. National Cancer Institute who led the study.

Why would heartburn matter when it comes to cancer?


More information

Chronic Heartburn Linked To One Of The Fastest

We all experience the occasional bout of heartburn, or acidreflux, especially after a particularly large or fatty meal. Although uncomfortable,that burning sensation in your chest likely doesnt cause much concern.

But did you know that heartburn has actually been linked toesophageal cancer?

Chronic heartburn, often caused by gastroesophageal refluxdisease, or GERD, putsyou at risk of developing a type of esophageal cancer called adenocarcinoma oneof the fastest-growing cancers in America.

Related: Eat this, not that, to avoid holiday heartburn

Innovatingbetter Screening And Treatment Options

At the Centerfor Esophageal Diseases at Baylor University Medical Center, my colleaguesand I have been conducting research to further our understanding of Barrettsesophagus and its relationship to esophageal cancer, and to help innovate bettertreatment techniques. With esophageal cancer on the rise, its critical that wediscover better ways to address Barretts esophagus, the primary risk factorfor this type of cancer.

For example, our recent studies have shown that GERD causesthe cells that line Barretts esophagus to burrow into deeper layers of theesophagus, where they can escape detection and be shielded from endoscopic treatment. Weare now actively studying how to prevent this burrowing process, so that we canidentify worrisome changes early on in Barretts esophagus.

Understanding how this condition develops and acts over timecan help improveour ability to eradicate Barretts esophagus once and for all and decreasepeoples risk of esophageal cancer.

While this type of esophagealcancer is rare, thecontext for developing this cancer should still be on your radar. This is particularly the case ifyou experience regular heartburn and you are 50 years of age or older.When Barretts esophagus is identified early and treated properly, cancer canbe prevented.

If youre at all concerned about your heartburn, dont procrastinate. Find a digestive specialist near you.

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Risk Factors Associated With Esophageal Cancer

The esophagus is a hollow, muscular tube that pushes food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue.

Esophageal cancer is a disease in which malignant cells form in the tissue of the esophagus. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it advances and grows.

There are two types of esophageal cancer:

o Squamous cell carcinoma: typically found in the upper to mid section of the esophagus.o Adenocarcinoma: found in the lower part of the esophagus near the stomach.

What Are The Risk Factors Associated With Esophageal Cancer?

While there are no known underlying causes of esophageal cancer, there are certain risk factors which can increase the chances of developing esophageal cancer.

Awareness & Early Detection

Learn what tests are used to screen for esophageal cancer.

Age & Gender

Age and gender also play a role in esophageal cancer. Studies have shown that men over the age of 55 do have a higher risk of developing esophageal cancer.

While it is true that older men have a higher risk of developing esophageal cancer, esophageal cancer is increasing rapidly and has increased over 700% in the past four decades.

Therefore, esophageal cancer diagnoses are increasingly affecting all ages, genders and ethnicities.

Esophageal Cancer: The Fastest Rising Cancer In The United States.

Make A Difference

Can Heartburn Lead To Cancer

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Learn why it’s important to see a doctor if you suffer from chronic heartburn

Everyone suffers the occasional bout of heartburn especially if you’ve eaten a whole plate of cheese fries or just one more slice of pizza. But when you start popping antacids twice a week or more for at least two weeks, it’s time to consider seeing your doctor.

Heartburn can be a symptom of gastroesophageal reflux disease , a condition where stomach acid repeatedly escapes up to the esophagus the muscular tube that transports food and liquid to the stomach. Unfortunately, the esophagus is not equipped to protect itself against acid or any backed-up food.

Over time, this reflux of stomach acid can damage the lining of the esophagus, replacing the squamous cells typically found in the esophagus with abnormal glandular cells that may have the potential to develop cancer.

The presence of these glandular cells in the esophagus is known as Barrett’s esophagus. About 10 percent of people with symptoms of GERD, also known as acid reflux, have Barrett’s esophagus.

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When Gerd Progresses To Esophageal Cancer

GERD develops when acid that digests food in the stomach washes up into the esophagus. Often it occurs in people who overeat or who lie down too soon after eating. It may also be caused by defects in the valve that connects the esophagus to the stomach or by a condition called hiatal hernia, which is when the upper part of the stomach pushes up through the diaphragm and into the chest.

After someone has had GERD for many years, it can advance to a condition called Barretts esophagus. Barretts is a defensive mechanism of your esophagus, Dr. Molena explains. When the esophagus is bathed in acid all the time, it wants to protect itself, and so the cells in the lining begin to change. These changes can advance to become cancer.

When patients develop Barretts esophagus, their GERD symptoms often disappear. Its typical for patients with esophageal cancer to tell me that they suffered from GERD for years, but then it went away and they stopped taking their GERD medications, which would have actually reduced their cancer risk, Dr. Molena says.

Not everyone with GERD has the typical symptoms, which are heartburn and regurgitation soon after eating. Up to 20% may have different symptoms, such as coughing or chest pain, a sore throat or hoarse voice, or even frequent sinus infections. Its important to talk to your doctor about any of these.

Adenocarcinoma Arises From Barretts Esophagus: The Crucial Ignored Link To Gerd

Barretts esophagus is an asymptomatic condition in which the cells of the lower esophagus are transformed into cells that are similar to those found in the intestinal tract. This poorly understood transformation is associated with chronic acid reflux over many years.

One study on rats, with experimentally induced chronic reflux, hinted at a new mechanism in the development of Barretts esophagus. Cytokines are small proteins that stimulate the mobilization of cells in the immune system. In an irritated esophagus, cytokines can cause a change in the structure and proliferation of cells and attract more inflammatory immune cells to the area. Thus, the inflammation of the esophagus could be due to cytokines secreted by squamous cells in response to contact with stomach acid, rather than the caustic effects of the acid itself, as had been previously thought.

Barretts esophagus can occur for a variety of reasons but GERD increases the chances of developing this condition by 3 to 5 times. Between 5 and 10 percent of people with GERD develop Barretts esophagus, with men twice as likely as women to do so. The condition usually develops after the age of 55.

Adenocarcinomas usually start at the end of the esophagus closest to the stomach, which makes sense since this is the area that is most exposed to the acid reflux sloshing back acidic contents of the stomach.

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Warning Signs Of Esophageal Cancer

Most warning signs of esophageal cancer are associated with problems related to eating, drinking, swallowing and digestion. In most cases, esophageal cancer doesnt cause symptoms until it has reached an advanced stage.

At Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, our specialists perform thorough evaluations, helping to detect esophageal cancer as early as possible. When a doctor can identify esophageal cancer in the early stages, successful treatment is more likely.

Structural Physiology And Aetiology

Chronic Heart Burn and Screening for Esophageal Cancer

Heartburn, indigestion and acid reflux all commonly occur in pregnancy, usually in the latter stage, although they may also accompany first trimester nausea and vomiting. Symptoms are largely due to the effects of progesterone, which relaxes the cardiac sphincter of the stomach, causing acid reflux. It is worse in women with multiple pregnancy and when the fetal presentation is breech, due to upwards pressure on the diaphrgam. Some mothers may experience a burning sensation at varying levels in the oesophagus, which will usually correspond to tender areas on the oesophagus reflex zones of the feet, relative to the level of heartburn. Mechanical distress also occurs at the junction of the oesophagus, cardiac sphincter and stomach due to changes within the abdominal/uterine cavities, the spinal kyphosis/lordosis and the inter-relationship between the shoulder and pelvic girdles. Heartburn is also often exacerbated by the weight of the breasts, particularly if the mother wears an ill-fitting brassiere, or if her general posture is poor with an accentuated thoracic kyphosis.

Joel E. Richter, Frank K. Friedenberg, in, 2010

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Complementary And Alternative Medicines

Functional heartburn patients often pursue complementary and alternative therapies as pharmacologic options are limited . An open-label, controlled trial of nine functional heartburn patients evaluated the efficacy of esophageal-directed hypnotherapy on heartburn symptoms . After completing seven sessions of weekly hypnotherapy, patients had a demonstrable improvement in visceral anxiety and emotional quality of life , and all patients reported a subjective improvement in heartburn symptoms. A clinical trial of 30 patients with refractory heartburn symptoms demonstrated that acupuncture with single daily PPI improved heartburn symptoms more than doubling the PPI dose . This is thought to be due in part to the effect of acupuncture on visceral hypersensitivity. In contrast to hypnotherapy and acupuncture, a prospective analysis of 22 patients, 13 with functional heartburn and 9 with functional chest pain, evaluating biofeedback demonstrated a significant improvement in symptoms in functional chest pain patients but no improvement in functional heartburn patients .


Progression To Esophageal Cancer

A small percentage of people with Barretts esophagus will develop cancer, and the number of cases in North America is rising.

Identifying cancer early really improves patient care and outcomes, says surgeon Richard Battafarano, M.D., Ph.D.

Cancer that has not spread to lymph nodes can be removed using minimally invasive endoscopic techniques. When the cancer is more advanced, surgical removal is required. In advanced cases, often when patients hadnt shown symptoms or been treated before the cancers discovery, chemotherapy or radiation treatments may be required before surgery.

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Chronic Heartburn Linked To Fastest

Weve all felt it: A little heartburn after a spicy Tex-Mex meal or after we eat way too much at a holiday feast. Even some of us who experience heartburn more frequently dont rush to the doctor with worry.

New information might make you think twice.

A recent study by the National Cancer Institute has connected chronic heartburn, typically the result of gastroesophageal reflux disease , with one of the fastest-growing cancers in America adenocarcinoma.

The most common forms of esophageal cancer are squamous cell carcinoma and adenocarcinoma, says Prashant S. Kedia, MD, gastroenterologist on the medical staff at Methodist Dallas Medical Center.

Each form tends to develop in different parts of the esophagus due to different genetic changes. Squamous cell carcinoma used to be the most commonly diagnosed form of esophageal cancer in the U.S., but that all started to change in the late 1990s.

A shift in esophageal cancer

Today, Americans are now more likely to be diagnosed with adenocarcinoma. And, while esophageal cancer is still considered a rare cancer, incidence rates of esophageal adenocarcinoma have increased for all age groups 30 and over since the 1970s.

Men, particularly Caucasian men over 50, are more at risk than women.

The exact cause of this mysterious change hasnt been uncovered, but experts suspect that rising obesity rates and poor diet are linked to the shift.

Heartburns connection to cancer

When is it time to see the doctor?

For Those Who Have Gerd The Best Way To Prevent Cancer Is To See A Doctor And Get Treated Early On Before Further Damage To The Esophagus Develops

Heartburn Center of California opens to help combat GERD ...

Whether you just have occasional heartburn or are already under a doctor’s care, you can decrease your chance of developing esophageal cancer by doing the following:

  • Do not start using tobacco products. If you currently do, quit.
  • Do not drink large amounts of alcohol.
  • If you are overweight or obese, lose weight.
  • Eat a diet rich in fruits and vegetables, especially raw ones.
  • If you have acid reflux or GERD, see your doctor and get it properly treated.
  • If you have already been diagnosed with Barrett’s esophagus, talk to your doctor about getting regular cancer screenings.

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Patient Values And Preferences

A systematic review of patient values and preferences34,35 found no evidence on how patients weigh the benefits and harms of screening. However, evidence on factors that contribute to willingness to be screened was found in 3 studies comparing endoscopic screening strategies .49 In 1 trial, among 1210 invited participants, 52% did not respond to the letter, 32% declined screening , 1% were ineligible and 0.2% cited difficulty attending.41 Two other studies had high stated or intended refusal rates , from anxiety, lack of interest, fear of gagging, unwillingness to be study participants, or reluctance to undergo transnasal procedures.45,49

Surveys and focus groups conducted by the knowledge translation team in support of this guideline reported that when considering harms relative to benefits, participants with chronic GERD had a moderate desire to be screened .50 For many of these respondents, individual or familial risk factors, personal beliefs or fear of missing an early diagnosis outweighed concerns about screening . For some, the low certainty of evidence and perceived risk of screening would have led to a decision not to be screened.50 Based on this range of observations from trials and within focus groups, values and preferences for screening are judged to be variable.

Symptoms Of Esophageal Cancer

Cancer of the esophagus is discovered through a series of symptoms, such as:

  • Difficulty swallowing, or dysphagia
  • Pneumonia
  • Esophageal bleeding, which appears as black stools

Most of us have had at least some of these symptoms, without having esophageal cancer. However, if you have a combination of these symptoms , it is important to see your doctor.

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What To Make Of The Findings

If these findings are confirmed by further studies of GERD and esophageal and laryngeal cancer, it may guide clinical surveillance of GERD patients in the future, Abnet says.

All observational studies have limitations and our study alone does not confirm that GERD raises the risk for all these cancers,” he says. “We expect that our publication may lead other researchers to test this hypothesis in future studies.

GERD is one risk factor for esophageal and laryngeal cancer, but not the most serious one. In the United States, tobacco and heavy alcoholic beverage intake are the primary causes of esophageal and laryngeal squamous cancers, so avoiding those exposures is the most important preventive measure, Abnet says.

Our findings should not alarm people diagnosed with GERD, he adds. The best course of action for those with GERD symptoms is to speak to their physician about lifestyle modifications or medical interventions that could alleviate their GERD symptoms and improve their quality of life.

In some cases, physicians may recommend additional specific tests and treatments for GERD, but whether these treatments could also reduce the risk of esophageal and laryngeal cancer remains to be determined, he adds.

Early And Subtle Signs Of Esophageal Cancer

Could your chronic heartburn put you at risk for esophageal cancer?

Health Check Certified By: Dr. Gerald Morris

Being diagnosed with any type of cancer is scary and life-altering. Even if youre very likely to fully recover and live a long, healthy life, the emotional and physical toll of dealing with cancer and any associated treatments is exhausting. When it comes to esophageal cancer, many warning signs begin early on and may not seem like a big deal at the time, but its important to know your body and be able to recognize any changes it goes through. It could save a lot of pain and suffering in the futureor even save your life.

While there are several early and subtle warning signs of esophageal cancer, many of them can be caused by other conditions. Please dont assume you have esophageal cancer, but it doesnt hurt to be proactive and see your doctor if youre experiencing several of these 15 signs

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