Can acid reflux lead to esophageal cancer?

Madhusudhan Sunkavalli, MD

Gastroenterology

Many of us have felt heartburn – a burning feeling in the chest – after eating certain foods. This can be a symptom of gastroesophageal reflux disease (GERD), a chronic form of acid reflux that occurs several times a week. GERD occurs when stomach acid or bile flows backward into the esophagus and irritates the lining. But can the damage it causes to the esophagus lead to cancer? Madhusudhan Sunkavalli, MD, explained how this disease and cancer are connected, as well as what you need to know about esophageal cancer.

GERD increases the likelihood of developing esophageal cancer, and 60% of individuals with this cancer report a history of GERD. Most people with chronic GERD, however, do not develop esophageal cancer, and predicting progression is difficult.

“Antacids or acid suppressants are good at improving the quality of life in people with acid reflux, but we are not sure if they help to prevent Barrett’s esophagus or potentially even esophageal cancer. It is not uncommon for us to see patients who have been experiencing symptoms of esophageal cancer for some time, leading to a more advanced cancer by the time it is identified,” said Dr. Sunkavalli.

What are other risk factors for esophageal cancer?

Many people who have risk factors will never develop the disease, but they have a greater chance. Some of the risk factors include:

• Age (over 50)
• Gender (male)
• Barrett’s esophagus (condition developed by chronic acid reflux damage)
• Gastroesophageal reflux disease (GERD)
• Tobacco and alcohol use
• Obesity
• Diet
• Workplace exposures (exposure to polycyclic aromatic hydrocarbons, silica and mixed dusts)
• Injury of the esophagus
• History of certain other cancers
• Human papilloma virus (HPV)
• Family history

What are the symptoms of esophageal cancer?

Trouble swallowing and weight loss. The most common symptom of esophageal cancer is having trouble swallowing. Many times, this will cause people to change their diet without knowing it. In order for the body to make it easier to swallow, more mucus or saliva is produced. Many patients complain as this causes them to lose weight without trying.

Other symptoms could include:

• Hoarseness
• Chronic cough
• Vomiting
• Hiccups
• Pneumonia
• Bone pain
• Bleeding into the esophagus
• Pain when swallowing

“Most esophageal cancers, unfortunately, do not show symptoms until they have reached an advanced stage,” said Dr. Sunkavalli.

Are there screenings for esophageal cancer?

As of now, there are no established guidelines for screening patients for esophageal cancer. About 93% of diagnoses are made while investigating individuals with symptoms, such as difficulty swallowing, painful swallowing, recurrent vomiting, unexplained weight loss, anemia, appetite loss or gastrointestinal bleeding, which can be associated with late-stage cancer.

Increased screening is suggested, but not required, by the American Society of Gastrointestinal Endoscopy for high-risk patients, defined as those with a family history of esophageal cancer or Barrett’s esophagus or patients with GERD and one other risk factor.

“At-risk patients should focus on prevention of esophageal cancer by monitoring additional risk factors,” Dr. Sunkavalli.

The most important risk factors to pay attention to include Barrett’s esophagus diagnosis, being over 50 years of age, GERD, being male, family history of Barrett’s esophagus or esophageal cancer, abdominal obesity and smoking.