Many people get the occasional heartburn. Usually, it occurs after eating too much, too late at night, or certain types of food. Chronic heartburn is the occurrence of heartburn symptoms daily or weekly over a period of time and can be more than just uncomfortable – it could increase your chance of esophageal cancer.
How many people have chronic heartburn and who is most at risk?
Occasional heartburn is common and no cause for alarm. Most people can manage the discomfort of heartburn on their own with lifestyle changes and nonprescription medications. Others are not so lucky.
“Statistics suggest about 44 percent of American adults will have heartburn at least once a month and at least 18 percent will have heartburn once per week,” Dr. Yacavone explains. “Chronic heartburn can affect any age group but as we get older we are at greater risk of problems. This is particularly true for older men or men who are obese. Smoking and alcohol consumption also increase the risk.”
What are the symptoms of heartburn?
Heartburn occurs when digestive acid escapes the stomach and irritates the delicate lining of the esophagus. This acid reflux can create a sensation of tightness, pain, or discomfort in the middle of the chest.
“Most people think of heartburn as that burning sensation behind the breast bone,” describes Dr. Yacavone. “For some people, symptoms also include the regurgitation of food or fluid backing up from the stomach into the back of the throat. Others may get chest pain, which we need to make sure is not related to a heart problem. Less typical symptoms include chronic cough and sore throat or difficulty swallowing.”
The pain some experience is often worse after eating, in the evening, or when lying down or bending over.
What is Barrett’s Esophagus and why is it a concern?
When the lower part of the esophagus is exposed to acid from the stomach, the cells begin to adapt and adjust to become more like cells found in the small intestines. This is referred to as Barrett’s esophagus. Dr. Yacavone has a unique way of describing this process.
“Barrett’s esophagus is a condition in which a portion of the lining of the esophagus changes from one type of tissue to another. Think of a high-traffic area in your house where the carpet gets worn down. You may decide to replace that area with a more durable type of flooring, like tile to prevent it from wearing down. That’s what the esophagus does. If an area is bathed with stomach contents over long periods, it replaces the surface with a new type of tissue.”
While this change in the cells can protect the esophagus from further damage caused by inflammation, people with Barrett’s esophagus may develop dysplasia, a condition that dramatically increases the risk of getting cancer of the esophagus.
“The problem is this new tissue forges a welcome mat for cancer cells,” cautions Dr. Yacavone. “Studies have shown that the presence of Barrett’s tissue in the lower esophagus increases the risk of esophageal cancer by 30 to 125-fold relative to patients who do not have Barrett’s.”
When should someone see a doctor?
Dr. Yacavone recommends that you take a proactive approach if you are experiencing acid reflux. “People need to realize that a little bit of heartburn is not necessarily anything to worry about, however, if you’ve had acid reflux over a long time period, you should discuss it with your primary care physician. There are good treatments for chronic heartburn including lifestyle changes that can make a difference as well as medications.”
Some tips to avoid heartburn:
- Choose foods wisely: avoid spicy foods, fried foods, and foods that are high in fat and sugar.
- Limit your alcohol intake.
- Take your time: avoid eating in a rush or on the go.
- Avoid big meals: try smaller, more frequent meals throughout the day.
- Do not eat right before bedtime.
- Elevate your upper body while sleeping rather than lying flat.
- Don’t stress eat: Avoid snacking when you are stressed or tired.
- Stop smoking
- Maintain a healthy body weight
If you continue to experience frequent (more than two times per week) or severe heartburn even after taking over-the-counter heartburn medications, or if your heartburn is accompanied by other symptoms such as chest pain or difficulty swallowing, you may need to see a gastroenterologist like Dr. Yacavone. Your gastroenterologist will likely want to perform an endoscopy procedure utilizing a lighted scope to examine your esophagus and digestive tract.
“An upper endoscopy is a simple procedure where I’ll look for issues that are contributing to you having heartburn regularly,” says Dr. Yacavone. “I’ll also be able to tell if there has been a development of Barrett’s Esophagus. I worry more about finding Barrett’s in someone who describes once-a-week heartburn for 20 years than someone who has had heartburn three times a week for six months. So it’s very important to seek help for chronic heartburn to get it under control before it causes damage or has other implications.”
What are the long-term effects of chronic heartburn?
For 90 percent of people with reflux, it’s a nuisance but not a health risk. However, for a small portion of the population over 40, it can lead to cancer. And, your risk of esophageal cancer isn’t necessarily tied to the severity or frequency of your symptoms.
“If left untreated, not only is the quality of your life reduced, but there are other more serious things that can occur, one being the development of Barrett’s esophagus,” explains Dr. Yacavone. “This is essentially what can lead to esophageal cancer. Your gastroenterologist can help to identify and monitor any signs of this before it leads to cancer and the prognosis for Barrett’s Esophagus is good if it’s caught early on. Not only that, your doctor can recommend the right treatment for you based on your age, health, and unique symptoms so you can better control your heartburn.”
In addition to cancer, untreated chronic heartburn can lead to non-life-threatening complications, such as scar tissue that makes swallowing solids and pills difficult, and ulcerations in the esophagus. Acids from reflux can affect the throat, leading to hoarseness and laryngitis. Some people, particularly those with very severe acid reflux, have reported voice changes. These same acids can also wreak havoc on tooth enamel when they make their way into the mouth.
Avoiding Complications of Reflux
Before you worry that your heartburn is leading you straight down the road to esophageal cancer, you should know there are several treatments available that can ease your heartburn and reduce your risk for complications.
Start with your primary care physician but if you’ve had issues for a while, consider seeing a gastroenterologist like Dr. Robert Yacavone. He and his fellow physicians at CMC Digestive Health specialize in treating issues with the esophagus and other conditions affecting the digestive tract. In short, be proactive and don’t ignore your heartburn. We can help to get rid of it and ensure it doesn’t lead to something worse.
Fellowship trained in Gastroenterology / Advanced Endoscopy at Mayo Clinic
Dr. Yacavone is Board-certified in Gastroenterology through the American Board of Internal Medicine (ABIM). His particular interest and focus is in the endoscopic diagnosis and treatment of biliary tract diseases (bile duct stones, bile duct infection, bile duct cancer), and pancreas disease (pancreatic cancer, chronic pancreatitis). Dr. Yacavone performs colonoscopy for colon cancer screening and performs advanced colon polyp removal (endoscopic mucosal resection and endoscopic full-thickness resection) which allows some patients with large precancerous polyps to avoid the need for surgery.