Clues for Cause of Esophageal Cancer

Bile may be key to controlling reflux disease

(RxWiki News) Like millions of people, you may have occasionally suffered from a bout of heartburn after eating spicy foods. But recurring heartburn can be a symptom of more serious health problems.

One serious problem is gastroesophageal reflux disease (GERD). With GERD, burning acid and bile from the stomach leaks backwards into the esophagus.

Scientists have recently found that this bile is playing a critical role in a condition that can lead to esophageal cancer.

"See your doctor if you have recurring heartburn."

Jeffrey Peters, MD, a surgeon specializing in the esophagus and stomach, at the University of Rochester Medical Center in New York, led a team to exam the effect of bile and acid on human esophageal cells.

Researchers discovered that the bile—but not the acid—may be triggering a pre-cancerous condition called Barrett’s esophagus.

Barrett’s esophagus is a common complication for GERD patients, and it’s the only known cause of a rare but potentially fatal cancer called esophageal adenocarcinoma.

For those who have Barrett’s esophagus, the normal tissue lining of the esophagus changes to resemble the lining of the intestine. The healthy skin-like tissue becomes red and smooth.

Researchers conducting this cellular study found that bile washing up from the stomach appears to turn off genes in healthy esophagus cells, causing this affliction.

On the other hand, the scientists noted that acid did not appear to alter cells in any major way.

Dr. Peters said that this is significant because current drug therapies for GERD focus largely on acid control and not bile, which up until now, has not been recognized as a factor in developing Barrett’s esophagus.

While acid-neutralizing drugs can be effective at masking GERD symptoms, Dr. Peters indicated that these drugs may not work in preventing Barrett’s esophagus.

Currently, the only way to stop all reflux components, including bile, is to surgically reconstruct the worn-down barrier between the esophagus and the stomach that causes reflux.

This barrier is a band of muscles called the lower esophageal sphincter, located where the stomach meets the esophagus. When functioning normally, it prevents reflux of stomach contents into the esophagus.

The authors concluded that further experiments will be necessary to verify their hypothesis, but if it is correct, then it may be possible to develop new drugs that block the effect of bile.

"Our ultimate goal is to understand the biology of Barrett's so that we may find drugs that inhibit or reverse the condition, thus preventing cancer," said Dr. Peters.

This study was published in the June 2012 edition of the Annals of Surgery and funded by the Department of Surgery at the University of Rochester Medical Center. No conflicts of interest were noted.

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Review Date: 
July 20, 2012