Does GERD Increase Your Risk of Esophageal Cancer? 

GERD, which stands for gastroesophageal reflux disease, occurs when stomach acid repeatedly flows back up the esophagus, the tube connecting the mouth to the stomach. This irritates the lining of the esophagus, causing heartburn and, in some cases, an influx of stomach acid into the throat and mouth. 

Occasional GERD — also known as acid reflux — usually isn’t harmful, but when it becomes frequent, the body may try to protect itself by altering the interior of the esophagus. The tissue that lines the esophagus gets replaced by tissue that resembles the lining of the small intestine, which is more resistant to stomach acid. This condition is known as Barrett’s esophagus. 

The vast majority of people with GERD do not develop esophageal cancer, nor do those with Barrett’s esophagus. However, having Barrett’s esophagus can significantly increase the risk of developing the cancer. 

For people with Barrett’s esophagus, treatment can lower that risk. 

What are the symptoms of GERD? 

The most common symptoms include: 

• Heartburn, usually after eating 
• Regurgitation of food or stomach acid 
• Upper abdominal or chest pain 
• Trouble swallowing 
• A sensation of a lump in the throat 

If GERD occurs at night, symptoms might include: 

• A persistent cough 
• Inflammation of the vocal cords 
• New or worsening asthma 

What causes GERD? 

GERD occurs when a muscle at the junction of the esophagus and the stomach doesn’t function properly. Normally, the muscle, called the lower esophageal sphincter, opens to let food pass from the esophagus to the stomach and closes once the esophagus has emptied. If it relaxes too long or too often, stomach acid can back up the esophagus. 

Who is most likely to develop GERD? 

The disease is most common in middle-aged and older white men, but it’s estimated to affect 20% of the overall population. People with certain medical problems may be at increased risk. These conditions include: 

• Swelling of the stomach lining 
• Sores or ulcers in the lining of the stomach, esophagus, or first section of the small intestine 
• Certain allergic conditions 

What should I do for occasional GERD? 

Occasional heartburn can be treated with a variety of over-the-counter medications, including: 

• Antacids, which may provide quick relief but don’t heal esophageal damage caused by stomach acid 
• Drugs known as histamine blockers, which decrease acid production in the stomach 
• Drugs known as proton pump inhibitors, which lower acid production and heal the esophagus 

When should I contact my healthcare provider about GERD? 

If you experience heartburn frequently or have bouts of heartburn over a period of months, it’s a good idea to go in for an exam. Individuals should also call their provider if: 

• Their GERD symptoms don’t improve with treatment or get worse 
• New symptoms appear 
• Vomiting or weigh loss occur 
• There’s trouble or pain with swallowing 
• There’s difficulty breathing 
• Small amounts of blood appear in the stool 

How is GERD diagnosed? 

In some cases, doctors can diagnose GERD based on the symptoms alone. In other cases, clinical tests may be used. Your care team will work with you to make you comfortable during these tests. Tests include: 

• Upper endoscopy, in which a thin flexible tube carrying a camera is inserted into the throat to examine the lining of the esophagus and stomach. The tube can also be used to collect a tissue sample that can be tested for Barrett’s esophagus. 
• Upper gastrointestinal series (also called a barium swallow), in which a patient swallows a metallic fluid called barium that, on an X-ray, enables doctors to view the esophagus, stomach, and top part of the small intestine 
• pH monitoring, which uses a thin plastic tube, threaded into the esophagus, to monitor the pH level, an indication of acidity. The tube connects to a monitor worn at the waist or on a shoulder strap that records pH levels for 24 to 48 hours 
• Esophageal manometry, a test that measures the rhythmic muscle contractions of the esophagus upon swallowing 

What are some of the treatments for GERD? 

Patients may be treated with prescription-strength proton pump inhibitors or histamine blockers. 

If medications don’t help or patients don’t want to use them for long periods, doctors may recommend a surgical procedure. These are often performed laparoscopically, requiring only small incisions in the abdomen. They include: 

• Fundoplication, in which the top of the stomach is wrapped around the lower esophageal sphincter to tighten the muscle and prevent acid reflux 
• Implantation of the LINX device, a ring of tiny magnetic beads that is wrapped around the junction of the stomach and esophagus. The ring is flexible enough to allow food to pass through but firm enough to prevent stomach acid from escaping 
• Transoral incisionless fundoplication, a new procedure in which the lower esophageal sphincter is tightened by partially wrapping the lower esophagus, using polypropylene fasteners to hold the wrapping in place 

Are there lifestyle changes that can reduce GERD symptoms? 

Doctors recommend limiting consumption of: 

• Fatty and fried foods 
• Chocolate 
• Alcohol 
• Citrus fruit and juices 
• Tomato products 
• Drinks with caffeine 

Also recommended are: 

• Eating smaller amounts 
• Quitting tobacco smoking 
• Waiting a few hours after eating before lying down or doing to bed 
• Losing weight, if needed 
• Raising the head of your bed about six inches 

What are the symptoms of Barrett’s esophagus? 

The symptoms of Barrett’s esophagus can be similar to those of GERD. They include: 

• Frequent heartburn and regurgitation of stomach contents 
• Difficulty swallowing food 
• Chest pain, in some cases 

Only about half of people with Barrett’s esophagus have symptoms of acid reflux. This may be because the change in the lining of the esophagus is less prone to become damaged or inflamed by the presence of stomach acid. 

People who have had problems with heartburn, regurgitation, and acid reflux for more than five years should check with their doctor about their risk of Barrett’s esophagus. 

How is Barrett’s esophagus diagnosed? 

A doctor will use an endoscope — a thin tube equipped with a light and camera — to look for signs of changing tissue within the esophagus. Normal esophagus tissue appears pale and glossy; tissue in Barrett’s esophagus appears red and velvety. 

With the endoscope, the doctor will remove a small piece of esophageal tissue for examination by a pathologist. Depending on the appearance of the cells under a microscope, the tissue may be classified as: 

• No dysplasia.  Barrett’s esophagus may be present, but the cells have not undergone precancerous changes 
• Low-grade dysplasia. Cells show small signs of precancerous changes. 
• High-grade dysplasia. Cells show many changes. 

How is Barrett’s esophagus treated? 

Treatment depends on the degree of change in the esophageal cells, as well as an individual’s overall health. 

Patients with no dysplasia are often advised to have a follow-up endoscopy in one year and then every three to five years if no changes occur. 

Patients with low-grade dysplasia may be advised to have another endoscopy in six months, with a follow-up every six to 12 months.  Treatments for this type of dysplasia include: 

• Endoscopic resection, which uses an endoscope to remove damaged esophageal tissue 
• Radiofrequency ablation, which uses heat to remove abnormal tissue 
• Cryotherapy, which uses an endoscope to freeze esophageal tissue with cold liquid or gas. After the tissue warms up, it’s frozen again, damaging the abnormal cells. 

Patients with high-grade dysplasia may be treated with endoscopic resection, radiofrequency ablation, or cryotherapy. Surgery to remove the damaged part of the esophagus and attach the remaining portion to the stomach is another option.