Acid reflux, Barrett’s esophagus and esophageal cancer: What’s the link?
December 08, 2020
Medically Reviewed | Last reviewed by an MD Anderson Cancer Center medical professional on December 08, 2020
Millions of Americans suffer from acid reflux. Also known as heartburn or acid indigestion, it can feel like an intense burning sensation in your chest that spreads to your throat.
That burning is caused by inflammation from the acid and bile in acid reflux, and it can progress to more serious conditions, such as Barrett’s esophagus, which is linked to esophageal cancer.
Here are answers to six common questions about Barrett’s esophagus.
What’s the link between acid reflux and Barrett’s esophagus?
Your digestive system works by channeling food down your esophagus and into your stomach, where acid and bile break it down. Nutrients are absorbed, and waste is passed on through the system.
At the bottom of the esophagus is a valve that keeps this acid and bile in the stomach, where it belongs.
Acid reflux happens when there is a problem with that valve, and acid travels back up the esophagus.
“If there's something wrong with the stomach, or you tend to overeat regularly, the valve struggles to cope. There's just too much pressure from the stomach,” says thoracic surgeon Wayne Hofstetter, M.D. “The pressure pushes acid out of the stomach and up into your esophagus.”
Long-term reflux causes such chronic inflammation that the lining of the esophagus starts to change. That’s when you may be diagnosed with Barrett’s esophagus.
“Barrett’s esophagus is a change in the composition of the cells that line the esophagus,” says Hofstetter. “The lining changes from something pearly, like the back of your hand, to something more velvety and smooth, like in your intestine.”
How is Barrett’s esophagus diagnosed?
Barrett’s esophagus does not have any symptoms. It’s usually discovered after someone seeks treatment for long-term acid reflux.
Talk to your doctor about your risk for developing Barrett’s esophagus if you frequently have acid reflux.
You doctor may order a screening exam called an endoscopy to check for Barrett’s esophagus. During an endoscopy, a lighted tube with a camera is passed down your throat to look for symptoms.
What if you’re diagnosed with Barrett’s esophagus?
If you have Barrett’s esophagus, you will likely need to get an endoscopy every three to five years.
“Because the cancer risk is so low with Barrett's, there has been no documented need for treatment,” says Hofstetter. “Treatment is limited to patients with a precancerous condition called dysplasia. These patients' cell abnormalities are one step beyond Barrett's esophagus, making their risk of esophageal cancer much higher.”
If pre-cancerous cells are found, a doctor will perform a minimally invasive procedure called radiofrequency ablation to remove them.
You will have an outpatient procedure under a mild anesthetic. Your doctor will use an electrode to remove the precancerous cells.
Does Barrett’s esophagus cause cancer?
More research needs to be done to understand the link between Barrett’s esophagus and esophageal cancer. But studies do show that some cases of esophageal cancer are associated with Barrett’s esophagus.
“A small number of people with Barrett’s will develop esophageal cancer,” says Hofstetter. “When I say small, I mean around 0.25% per year.”
Your age, gender and race also affect your risk for esophageal cancer.
“The typical pattern for esophageal cancer is a white male, over 60 years old and overweight,” says Hofstetter. “We don’t know yet exactly why all those things fit together, but the association with reflux is there. The other big cause is smoking.”
How can you reduce your risk for Barrett’s esophagus?
You can reduce your risk for Barrett’s esophagus if you avoid the long-term inflammation caused by acid reflux.
That means watching your diet, as well as when and how much food you eat.
“Eating a heavy meal with a lot of fried food, drinking alcohol with dinner and then going to bed on a full stomach -- that's reflux city,” says Hofstetter. “Smoking also increases the risk of Barrett’s esophagus.”
To avoid acid reflux:
- Avoid tobacco and alcohol
- Eat a plant-based diet
- Don’t eat too close to bedtime and keep evening meals light
- Maintain a healthy weight
- Watch out for reflux triggers like caffeine or peppermint
Can you take medications to reduce your risk for acid reflux?
Medications to treat reflux do not reduce your risk.
“Medications don't stop reflux,” says Hofstetter. “They stop the symptoms, and over-the-counter medications themselves also could be potentially damaging. They have been linked to increased risk for kidney disease and dementia.”
Even though the risk for esophageal cancer from Barrett’s esophagus is low, it’s still important to do all you can to embrace a healthy lifestyle. And talk to your doctor if your symptoms of acid reflux do not go away.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
If there's something wrong with the stomach, or you tend to overeat regularly, the valve struggles to cope.
Wayne Hofstetter, M.D.
Physician