When Heartburn Is More Than Heartburn

By Atilla Ertan, MD, FACP, MACG, AGAF Medical Director of the Ertan Digestive Disease Center, the Gastroenterology Center of Excellence at Memorial Hermann–Texas Medical CenterProfessor at UTHealth Medical School

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It is the fastest growing cancer in the US today, increasing at a staggering rate of 600% in the last 35 years. It is also one of the deadliest cancers; this year alone, the American Cancer Society estimates about 18,000 new cases will be diagnosed and 85% of those will not survive. It has claimed the lives of people such as beloved baseball great Harmon Killebrew, Hollywood legend Humphrey Bogart and even the biological father of the Kardashian sisters, Robert Kardashian, Sr. It is the cancer that is quietly killing America: Esophageal cancer.

April has been designated Esophageal Cancer Awareness Month. It is time to get the word out about this highly preventable disease. Knowledge is power and earlier detection means more lives saved; if caught in an early stage, esophageal cancer is easily treatable and highly curable.

The crucial link is heartburn. In the US, esophageal cancer is most often caused by heartburn and, according to the American College of Gastroenterology, as many as 10 million Americans reportedly experience heartburn every single day. No doubt you yourself are familiar with the feeling: That burning pain in the throat and/or chest just behind the breastbone that occurs shortly after eating and lasts anywhere from a few minutes to several hours. The most common causes of heartburn or acid reflux include: Smoking, alcohol, carbonated drinks, coffee, chocolate, spicy foods, fatty or fried foods, anything tomato-based like pizza or spaghetti ... basically, the typical American lifestyle and diet!

Heartburn can also be triggered by eating an especially heavy meal and then lying down or by being overweight in general. In fact, the recent rise in esophageal adenocarcinoma – cancer of the glandular cells in the esophagus caused by chronic acid reflux – directly parallels the rise of obesity in our nation. It has increased 350% in the last 10 to 15 years and is now the most common form of esophageal cancer, occurring in 9 out of 10 patients, according to the Esophageal Cancer Action Network. Mirroring this, data from the Centers for Disease Control and Prevention indicates that, in 1990, the US obesity average was only 12%. Fast-forward 20 years to 2010 and that number jumped to 36%, marking a 200% increase.

But, you may be asking, how does chronic heartburn turn into cancer? Persistent heartburn or gastroesophageal reflux disease (GERD) is loosely defined by suffering from heartburn at least two or more times per week. This constant presence of stomach acid in the esophagus can cause the cells in the esophagus to literally change, leading to a condition known as Barrett’s esophagus. Once this condition is diagnosed, patients have a 30- to 125-fold increased risk of developing esophageal cancer. The American Gastroenterological Association estimates there are more than 3.3 million Americans currently living with Barrett's esophagus.

It is important to note that there are some contributing factors to developing esophageal cancer that cannot be controlled. For instance, the lifetime risk for men is about 1 in 125 while, in women, it is only about 1 in 435. Age also plays a decisive role – about 8 out of 10 people diagnosed are between the ages of 55 and 85. But unlike some other cancers, esophageal cancer may also be highly preventable with just a few simple, yet significant lifestyle changes:

Get in shape. Obesity leads to acid reflux which, as demonstrated, is substantially responsible for the rapidly increasing rates of esophageal cancer. Make it a personal goal to lose weight by exercising regularly, three to four times a week. If necessary, consult with your doctor first.

Eat well. Make the super fatty and fried, drive-thru foods the exception not the norm. Try to eat more lean proteins, whole grains and lots of fruit and vegetables. Avoid certain foods and beverages such as coffee in any form, caffeinated drinks, peppermint, chocolate, alcohol, citrus fruits and juices, and tomato products.

Article written by Atilla Ertan
MD, FACP, MACG, AGAF Medical Director of the Ertan Digestive Disease Center, the Gastroenterology Center of Excellence at...