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When antacids aren't enough

That chronic heartburn could be a sign of something more serious. Doctors are seeing more cases of rare but deadly esophageal cancer.

April 10, 2006|Shari Roan | Times Staff Writer

Heartburn, that almost quintessential American medical malady, now appears to be driving the nation's fastest-increasing type of cancer. And the antacids used to ease the symptoms could, in some cases, do more harm than good.

The cancer, a type of esophageal disease called adenocarcinoma, is relatively rare. However, incidence has jumped sixfold in the last 30 years. No one knows exactly why esophageal cancer is on the rise, but experts say heartburn is the natural suspect.

About 60 million Americans have occasional symptoms of heartburn -- a burning feeling in the chest, regurgitation and nausea. About 800,000 have chronic heartburn, attacks several times a week over many years -- a condition known as gastroesophageal reflux disease or GERD.

Esophageal adenocarcinoma affects only 23 in 1 million people. But that's up from fewer than 4 cases in 1 million people in 1975, and doctors think that Americans' super-sized eating habits are largely to blame.

"This type of cancer is really only common in countries that have a lot of gastroesophageal reflux," says Dr. Kenneth DeVault, a trustee of the American College of Gastroenterology and a professor of medicine at the Mayo Clinic in Jacksonville, Fla.

About 7,000 Americans are diagnosed each year with esophageal adenocarcinoma, with white men older than 55 at highest risk. Because it's often detected at a late stage, only 14% of people survive for five years after diagnosis. The usual symptoms are difficulty swallowing and the feeling of food getting stuck in the esophagus. Pain and bleeding can also occur.

"One of the big problems is if you wait until it produces symptoms, it's almost impossible to cure," DeVault says. "The idea now is to find the problem early before the patient develops an incurable problem."

Doctors now are warning people who have had severe gastric esophageal reflux disease for many years that they shouldn't keep popping Tums and over-the-counter Pepcid instead of seeing a doctor. A physician's visit is crucial, they say, to make sure sufferers don't have cancer or a precancerous condition.

The esophagus is the feeding tube that connects the throat to the stomach, where acid and enzymes digest foods. Overeating, eating spicy foods, obesity, pregnancy and other conditions can cause the contents of the stomach to back up into the esophagus, triggering heartburn.

Over time, the reflux of acid and stomach bile can cause cells in the lining of the esophagus to change and resemble the colon more than the esophagus. An estimated 3% to 15% of people with GERD have this condition, which is called Barrett's esophagus. Adenocarcinoma is usually, but not always, preceded by this condition.

"We think some people develop a mutation because the lower esophagus is trying to adapt to all this acid and injury," says Dr. William Lyday, a gastroenterologist and assistant clinical professor at Emory University. "It develops a new type of lining that is much more resistant to acid."

Among people with Barrett's esophagus, the risk of developing adenocarcinoma esophageal cancer is 30 to 125 times higher than average, according to the National Institute of Diabetes & Digestive & Kidney Diseases. Roughly 2% of people with Barrett's will develop cancer.

Sometimes the development of Barrett's -- by changing the lining of the more sensitive esophagus to something more like the colon -- will even cause heartburn symptoms to go away, masking a potentially dangerous condition, Lyday says.

Bill Snell, 64, developed chronic heartburn in his late teens. By the time he was in his 40s, however, the symptoms had stopped. "I thought, OK, I don't have that anymore."

Not true. Several years ago, the Westlake Village man was dining in a restaurant when a piece of meat lodged in his throat. After the meat was removed, Snell underwent an endoscopy and learned that he had Barrett's esophagus. He had the abnormal tissue removed in 2004. "If I hadn't had an endoscopic procedure, I wouldn't have known it," he says.

Because of the deadly nature of esophageal cancer -- and its rising rate in the United States -- experts agree that identifying and treating chronic heartburn and Barrett's are more important than ever. According to DeVault, anyone older than 50 who has had symptoms of chronic heartburn for 10 years or more should consult a doctor.

It's not practical to screen every GERD patient for Barrett's esophagus, because endoscopy requires sedation and costs about $1,000. But those at high risk for Barrett's are usually advised to undergo endoscopy every few years, in addition to taking medications to control acid reflux. If suspicious cells are found during the endoscopy, a biopsy is performed, DeVault says.

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