Cutting Heartburn Pain Could Lead To Cancer

Main Category: Acid Reflux / GERD
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 12 Dec 2005 - 3:00 PDT

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For many people, the holidays are a time to indulge in chocolate, alcohol and high-fat desserts - the very foods that can bring on heartburn. While one in three adults reports having heartburn at least once a month, for about one in 10, it's much more frequent.

Frequent heartburn is usually due to a weakness of the valve at the top of the stomach, which allows stomach acid and bile to leak into the esophagus, where it causes irritation. That condition is called gastroesophageal reflux disease, or GERD.

If that weren't painful enough, frequent heartburn and GERD can lead to a more serious problem. Recent research has found that continued use of acid-suppressing heartburn medications without proper doctor supervision can dramatically increase the risk of developing cancer of the esophagus, the passage that connects the throat to the stomach.

In the last three decades, cases of esophageal cancers have increased quickly, and it is now the sixth leading cause of cancer death, says Jeffrey Hagen, MD, associate professor of surgery in the Keck School of Medicine of USC. The increase in esophageal cancer may be linked to an increase in use of more-effective antacids now available over the counter, he said. They are now the second-most commonly used drugs, after medications to reduce cholesterol.

"Acid reflux now has new implications," Hagen says. "There is a large number of people taking antacid medication without any supervision to see if they're at risk of cancer. That worries me a lot."

The new generation of antacids that go a step beyond Tums or Rolaids and actually reduce the amount of acid released in the stomach don't solve the underlying problem of a leaking stomach valve. Consequently, low-acid liquids that leak into the esophagus after taking one of the drugs irritate it in a new, more dangerous way, even though heartburn symptoms have disappeared, Hagen says.

If continued, over time the cells lining the esophagus change, leading to an increased risk of cancer of about 40 times that of people with normal cells.

Such changes can be detected. Doctors can first test for GERD and a leaky upper stomach valve, to see if stomach liquids are still going into the esophagus. They can also monitor the acidity of those liquids to keep the levels in a range that avoids both heartburn symptoms and esophageal irritation.

Hagen, who performs surgeries to remove cancer in the esophagus and to repair leaky stomach valves, says even doctors are not usually aware of the risk of using antacids without screening.

"There's a high death rate from this cancer, because it's not being picked up early," he says. "Surgeons are the ones who are seeing the increase."

He recommends people with a history of heartburn at least twice a week and who take antacid medication see a specialist for screening, even if their heartburn symptoms go away.

University of Southern California
1975 Zonal Ave
Los Angeles, CA 90033
http://www.usc.edu

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