No Signs Doesn't Mean No Disease

Esophageal cancer risk is greater in acid reflux patients

(RxWiki News) If you have a health problem but no symptoms, you may not even know that you are sick. Some people with gastroesophageal reflux disease (GERD), or acid reflux disease, have this problem.

Not knowing that you have a disease means that you might go without treatment, leaving room for the disease to get worse. Acid reflux patients who have mild or no symptoms of their disease are more likely to get cancer than those with really bad acid reflux symptoms.

"Get screened for cancer if you have heartburn."

Blair A. Jobe, M.D., a professor and director of esophageal research and esophageal diagnostics and therapeutic endoscopy at the University of Pittsburgh, and colleagues found that many patients with adenocarcinoma - a cancer that often affects the esophagus - did not know they had Barrett's esophagus, a condition that increases the risk of cancer.

Acid reflux disease can lead to Barrett's esophagus. In patients with Barrett's esophagus, the lining of a patient's esophagus has changed into something more like the lining of the intestine. This change usually happens because of repeated contact with acids that come up from the stomach as a result of acid reflux disease.

According to Dr. Jobe, most patients with bad acid reflux symptoms are tested for Barrett's esophagus, while those with little to no symptoms are not tested. Nevertheless, patients without symptoms can go on to develop Barrett's esophagus. As a result, says Dr. Jobe, many acid reflux patients do not know they have Barrett's esophagus until it is too late and the condition has turned into cancer.

In order to come to these findings, Dr. Jobe and his fellow researchers studied 769 acid reflux patients who were getting their first upper endoscopy - a screening test in which a small camera is led through the esophagus and stomach to look for tissue changes.

The patients were put into one of three groups. Patients in the first group had been recommended to get an upper endoscopy regardless of their symptoms. Patients in the second group had ordinary symptoms of acid reflux, such as heartburn, regurgitation, and trouble swallowing. Patients in the third group less common symptoms like hoarseness, the need to clear the throat, mucus, coughing, and feeling a lump in the throat.

Almost 16 percent of the study's participants had Barrett's esophagus or adenocarcinoma.

Patients who were taking proton pump inhibitors (PPIs) - acid reflux drugs that lower the production of acid - were 61 percent more likely to have Barrett's esophagus or adenocarcinoma if they said they had no serious acid reflux symptoms, compared to patients taking PPIs that said they had serious symptoms.

Dr. Jobe says these results show that even acid reflux patients without symptoms should get screened for Barrett's esophagus. If patients are screened early enough, the chances of spotting Barrett's esophagus before it turns to cancer are much better.

This study - which is published in the Archives of Surgery - was financially supported by the Robert Anthony McHugh Research Fund for the Prevention and Early Detection of Esophageal Cancer; the David Gold and Irene Blumenkrantz Esophageal Cancer Research Fund; the Sampson Family Endowed Chair; the UPMC Heart, Lung and Esophageal Surgery Institute; the American Surgical Association Foundation Fellowship Award; and grants from the National Institutes of Health.

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Review Date: 
July 19, 2011