Just about everyone experiences heartburn and indigestion once in awhile, but people with a type of long-term heartburn should make sure they don’t have a more serious problem

Just about everyone experiences heartburn and indigestion once in awhile, but people with a type of long-term heartburn called gastroesophageal reflux disease, or GERD, should talk to their doctors about getting a test called an endoscopy to make sure they don’t have a more serious problem.

GERD is a disease of the esophagus (the food tube that runs from the mouth to the stomach). The esophagus has a valve at the bottom that opens to release food into the stomach and closes to keep acidic stomach juices out. That valve is faulty in a person with GERD and doesn’t stay closed properly after the person eats. Acidic stomach juices enter the esophagus and a person feels heartburn and indigestion. 

If left untreated, the stomach acid can erode the lining of the esophagus. Over time, the cells lining the esophagus change so they can tolerate this acid backup. The esophagus cells become more like the cells that line the stomach or intestine.

Barrett’s Esophagus: A Risk Factor for Cancer

When this cell change happens, the disease is called Barrett’s esophagus. Barrett’s esophagus is relatively common, and most people with Barrett’s do not get cancer, but Barrett’s is a risk factor for the development of a type of esophageal cancer called esophageal adenocarcinoma. Adenocarcinoma of the esophagus is increasing in the Western world, and fewer than 15% of people survive beyond five years once they are diagnosed.

Because the outcomes of adenocarcinoma treatment are so poor, many doctors are looking at finding and treating cases of Barrett’s to prevent this cancer from developing.

Unfortunately, almost 95% of the people diagnosed with esophageal adenocarcinoma never knew they had Barrett’s esophagus. There are no early warning signs of esophageal cancer. This is why it might be prudent to receive an endoscopy if you suffer from chronic heartburn.

Diagnosing Barrett’s

During the endoscopy, a doctor puts a small tube with a camera down your food tube to look at the lining. If any signs of Barrett’s esophagus are present, such as changes in color and texture, the doctor will take a small sample, called a biopsy and examine it under the microscope to see whether you, in fact, have Barrett’s esophagus.

If you have Barrett’s esophagus, your doctor will schedule periodic tests—every three to five years or so—to make sure you do not develop cancer.

In addition, your doctor will treat the original reflux disease, explains Stuart Spechler, MD, head of the gastroenterology department at VA North Texas Health Care Systems and a spokesperson for the American Gastroenterological Association.

“We want to prevent cancer from developing,” he says. “I think it is a good idea for patients who have chronic symptoms of GERD, heartburn, and regurgitation to speak to their physician about the possibility that they might have Barrett’s and whether they should get an endoscopy.”

This is especially important for white men, aged 50 or older, who have experienced reflux symptoms for a long time, because they are at highest risk for developing this type of cancer. Another high-risk group is people who are obese.

Blair A. Jobe, MD, professor and director of esophageal research at the Pittsburgh University School of Medicine, adds that people whose GERD is well controlled with medication but who cannot stop the medication without suffering symptoms again should also talk to their doctor about getting an endoscopy.

That faulty valve causing the GERD in the first place can be repaired with surgery, but most people take medications called proton pump inhibitors that stop the stomach from making acid, and they often feel much better.

Control of Symptoms Doesn’t Necessarily Mean Control of Cancer Risk

Jobe participated in a study that found that even though patients with GERD are feeling better because they are not suffering heartburn all the time, they might still have Barrett’s. Therefore, they might still be at risk for cancer. The study showed that people with GERD who are not having symptoms, either because they are well controlled on medication or because their esophagus lining has changed as described above, are at higher risk of Barrett’s esophagus, and cancer, than people who have severe symptoms of GERD.

“Primary care physicians prescribe these medications, and the patient’s symptoms go away, so they assume that the reflux is adequately treated, but in some cases they just become asymptomatic (without symptoms) and are still at risk for cancer,” explains Jobe.

However, this is not an issue that everyone with heartburn needs to panic about, he was quick to add, and they shouldn’t just stop taking their medication without talking to a doctor.

These GERD medications are very helpful in stopping the pain and heartburn associated with GERD. Instead of panicking, talk to the doctor about whether a test is needed and schedule the test if the doctor recommends it.

If Barrett’s is present, doctors can remove the diseased tissue in a procedure called radiofrequency ablation, which burns away the cells that changed. “If the tissue is ablated, the esophagus lining will revert back to normal esophagus tissue,” Jobe says.

A Potential New Technique

Jobe is testing a form of endoscopy called unsedated endoscopy, which can be done in a doctor’s office. Unsedated endoscopy uses a very thin scope and allows the patient to remain awake. Because there is no sedation, the test would have fewer side effects and avoids the need for patients to take a day off from work to have the procedure. This test is not yet available.

There is no way to prevent GERD, but both physicians suggest that people avoid fatty foods and, if they are overweight, try and lose weight.