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GERD, Barrett’s Esophagus, and the Link to Esophageal Cancer

April 28, 2021

If you suffer from chronic acid reflux, or GERD – which is acid reflux that occurs at least one to two times per week – you may be at risk for esophageal cancer. Esophageal cancer is generally rare, impacting nearly one in every 125 men and one in every 417 women, according to the American Cancer Society. Like all cancers, it’s incredibly important to take preventative measures and try to catch it early.

The good news – continued medical management and lifestyle modifications can keep this risk at bay, says Dr. C. Jonathan Foster, gastroenterologist with Jefferson Health – New Jersey.

What is the link between GERD and esophageal cancer?

The simple answer – Barrett’s esophagus. Barrett’s esophagus is a more advanced complication of GERD that causes cancer to develop. It’s caused by repeated damage – typically for five or more years – to the esophageal lining, or “mucosa,” from stomach acid, explains Dr. Foster.

This long-term irritation causes what’s known as metaplasia and dysplasia – or abnormal changes to the cells – which promotes cancer growth.

Keep in mind, GERD will not always progress into Barrett’s esophagus, and Barrett’s esophagus will not always progress into cancer, adds Dr. Foster. “Studies show that around 10-15 percent of patients with GERD develop Barrett’s esophagus – many of whom neglect proper follow-up with their doctors to effectively reduce their acid reflux.”

How is Barrett’s esophagus monitored?

When you have Barrett’s esophagus, it should be checked, via regular endoscopy, every 1-3 years, depending on symptoms and level of dysplasia. In some cases, treatment is available that can aid in the resolution or temporary reversal of the condition.

There are four main categories of dysplasia that doctors look at, notes Dr. Foster. They are:

  1. Non-dysplastic, or no presence of dysplasia. This calls for surveillance every 3-5 years. 
  2. Low-grade dysplasia. People with low-grade dysplasia may benefit from treatments, such as radiofrequency ablation (heats and destroys diseased tissue) or cryotherapy (freezes and destroys diseased tissue), until the Barrett's esophagus has resolved. 
  3. High-grade dysplasia. This may be treated in similar fashion to low-grade dysplasia, or, in some cases, it may require an endoscopic resection, or removal, of the affected tissue.
  4. Indefinite for dysplasia. People who are indefinite for dysplasia may benefit from high-dose acid suppression and repeat endoscopy to see if dysplasia resolves, prior to performing radiofrequency ablation.

“People with non-dysplastic Barrett’s esophagus have as low as a 0.2 percent chance of developing cancer each year; people with high-grade dysplasia, around 0.7 percent,” said Dr. Foster.

Worsening symptoms of Barrett’s esophagus that may point toward cancer and warrant testing sooner include chest pain, difficulty swallowing, black or bloody stools, and unintentional weight loss.

What can you do?

Research shows that unhealthy lifestyles that involve smoking; heavy drinking; diets full of overly processed foods; and lack of physical activity increase the risk for all cancers, including esophageal. “Taking mitigating steps against these behaviors will help prevent esophageal cancer progression, even if you have Barrett’s esophagus,” explained Dr. Foster.

Equally as important is CONTROL over your condition. Daily treatment, usually with a PPI (protein pump inhibitor) can help ease symptoms and reduce overall cancer risk. If you feel like your symptoms are getting worse – and taking over your life – talk to your doctor as soon as possible.

To learn more about Gastroenterology and other Primary & Specialty Care services offered at Jefferson Health – New Jersey, click HERE.