Acid reflux is a common occurance among adults, enough so that outside of the occasional bout of discomfort, we hardly pay it any mind. But for many who suffer from chronic reflux disease, known as GERD, the implications can be much more serious. In particular, GERD is the primary risk factor for esophageal cancer, a fatal disease that usually occurs in the lower part of the esophagus.

Understanding GERD

Acid reflux is when acid backs up from the stomach into the esophagus due to the relaxing of the sphincter muscle that normally keeps digestive juices in the stomach. There are a number of factors that may cause this to become a long-term issue, such as hiatal hernia, obesity, lifestyle factors such as smoking eating habits, and pregnancy.

Gastroesophageal reflux disease (GERD) is very common in our society. Many patients with regular (even one episode per week) heartburn or reflux symptoms treat themselves with over-the-counter antacids.  Mostly, these are relatively harmless. However, after a long period of time, acid reflux may lead to a condition known as Barrett’s esophagus, which is a risk factor for esophageal cancer.

Barrett’s esophagus is when the cells lining the walls of the esophagus are modified over time due to chronic reflux. The cell tissue changes until it becomes similar to the structure of the intestine. The reason this is a problem is that it becomes much more likely to develop into cancerous cell tissue over time once this change has taken place.

There are no specific symptoms for those who develop Barrett’s, which is estimated to be about 10% of people who live with chronic GERD. So if you have longterm GERD symptoms (longer than 5 years), it is critical you get screened for esophageal cancer!

Screening for Barrett’s and Esophageal Cancer – The Endoscopy

The process of screening for these diseases is called an upper endoscopy. Once your primary doctor and you have determined the need for this preventive procedure, you’ll need to schedule an appointment with a specialist known as a gastroenterologist. The procedure itself is straightforward and painless. Be sure to have a driver on hand for after the procedure – you’ll be unable to operate a motor vehicle for day!

You are laid on a bed and given sedation medications. Typically, you will be fully unconscious for the procedure, though some doctors may put you in conscious sedation. You should speak with your doctor about this to find out what is right for you. After you are sedated, the gastroenterologist inserts a tube into your mouth and gently advances this tube into your esophagus and deep into the stomach and the small intestine. The endoscopy tube has a light and a camera to visualize your internal gastrointestinal tract. This procedure very accurately examines your entire esophagus for inflammation, ulcers, erosions, bleeding, infections, Barrett’s, and cancer.

If there is evidence or suspicion of inflammation, ulcerations, erosions, Barrett’s, or cancer, biopsies are obtained. Once samples have been taken for biopsy, the procedure will be finished and you’ll be brought back to the waking world. There is typically no lingering pain or discomfort associated with this procedure, though you’ll need to take the rest of the day off and avoid driving or operating heavy machinery due to the drugs remaining in your system.

What your Results Mean

In the event that your gastroenterologist found something he or she didn’t like and took a biopsy, you’ll get the results back, typically within a few days to a week.

• If the initial endoscopy is normal, surveillance EGD may be performed based on future symptoms.
• If Barrett’s esophagitis is diagnosed by biopsy samples (pathologists make a histological diagnosis) but no dysplasia is found (meaning no precancerous cells) you will continue on acid reflux medications, and you will receive a repeat upper endoscopy in three years.
• If Barrett’s is found with low-grade dysplasia, the gastroenterologist will perform an upper endoscopy with extensive biopsy sampling in one year.
• If Barrett’s is found with high-grade dysplasia, but without cancer, doctors take immediate action after discussing options with you.
• If cancer is found, doctors take immediate action after discussing options with you.

When gastroenterologists consider the decision for Barrett’s surveillance, the most critical factors to them are your health, well-being, and survival. This is because esophageal cancer is very fatal.

Your Life with GERD

Patients with established esophagitis or Barrett’s esophagitis typically take a class of medications known as the proton pump inhibitors. The public knows of these medications by their brand names. They are Prilosec, Prevacid, Aciphex, Nexium, Protonix, Zegrid, and Kapidex. Many of these medications are available over the counter without a prescription. The use of proton pump inhibitors may significantly decrease your chances of developing dysplasia, a risk factor of esophageal cancer. They have also been shown to heal erosions and inflammation of the esophagus.

For patients who have no biopsy evidence of Barrett’s esophagitis, medications known as H2 blockers may be used. They includes brand names like Zantac, Pepcid, and Tagamet. Discuss these and other options with your doctor.

Finally, and perhaps most importantly, it is important to manage your diet and lifestyle to keep GERD under control and prevent the onset of esophagul cancer. Smoking, as well as many foods and beverages, such as tomatoes, onions, chocolates, and large volumes of tea, coffee, and carbonated beverages increase acid reflux in many patients. Eating or drinking within 3 hours of lying down can trigger reflux episodes in many patients. And overeating, as well as overindulging in alcohol, tends to trigger reflux in susceptible individuals.

Do your best to learn what triggers your reflux symptoms, and you’ve taken the first step toward better health!

Colonoscopies are not something we talk about very often in polite company. The word “colonoscopy” is often accompanied by a grimace or a chuckle. Unlike, say, mammograms or pap smears, colonoscopies are rarely something parents discuss with their children, nor are the risk factors or signs regularly discussed. This is extremely unfortunate, because screening for colon cancer is something everyone needs to be familiar with – and while colonoscopies are not the only method of screening, they are by far the most accurate.

Colorectal cancer screening is recommended for virtually everyone starting in their mid-40s or early 50s, and even earlier for some high-risk individuals. Like many cancers, colon cancer develops originates in a specific location before potentially spreading to other areas of the body (metastasizing), often fatally. But unlike a number of cancers, colon cancer often develops slowly and in a predictable manner. Furthermore, pre-cancerous growths in the colon, known as polyps, can often be detected long before they actually become cancerous, allowing for safe and effective removal. This means colon cancer is particularly preventable and survivable compared to many cancers – but only if it is screened for and discovered early!

What You Need to Know

First off, knowing when to start talking to your doctor about screening is the most important step. In most cases, it is advised that someone with no symptoms should start screening at age 50. For African-Americans, the age to begin screening is instead 45 due to increased risk of colon cancer. If you have no symptoms and are not considered high-risk, you should talk to your doctor about starting the screening process as you approach this age.

So that leaves those with prior symptoms and those who are considered high-risk. First we’ll talk about how to determine if you are a high-risk case, and then we’ll talk a bit about symptoms that might suggest you need to talk to your doctor about early screening.

In most cases, having relatives who have been diagnosed with colon cancer is a good reason to talk to your doctor about your risk level. If someone in your immediate family has or had colon cancer, you’re likely to need your first screening at the age of 40, or 10 years before your relative’s diagnosis – whichever comes first. That means if your father or sister had colon cancer diagnosed at the age of 45, you’re probably going to need to be screened at age 35 yourself.

What about your extended family? Generally, if you have two or more second-degree relatives diagnoses with colon cancer, you’ll need to start screening at age 40. If you have less than two relations diagnosed with colon cancer, your recommended screening date is once again 50 years of age. In any case, it’s worth discussing with your doctor if your family has a history of colon cancer in order to make sure you both understand the correct timeframe to begin screening.

Finally, there are those who develop symptoms before the age of their first regularly-scheduled screening. There are, unfortunately, often no symptoms of early cancer. Symptoms that may develop over time include changes in bowel habits such as thin, string-like or pellet-like stools, changes in stool consistency, loose stools, diarrhea or constipation. Patients with polyps or cancer may have rectal bleeding or concealed bleeding detected only by a paper smear test or “card test”. A smear of stool is placed on the card which is analyzed in a lab for the presence of blood. Patients with cancer may become anemic, lose weight, and develop abdominal pain. Ideally, polyps can be detected by a scheduled colonoscopy before any symptoms arise, but it’s important to speak to your doctor if you experience any of the above.

The difference between early detection and late detection of colon cancer can be life and death. And knowing when to speak to your doctor about scheduling your first screening exam is the key to beating colon cancer before it strikes. Don’t be afraid to start the conversation!