Acid, Heartburn, and Cancer

by Robert Sewell, MD, FACS

Older Man

Most heartburn sufferers are aware of the connection between chronic gastric reflux and the development of a condition known as Barrett’s esophagus. Likewise, numerous articles have been written describing how Barrett’s carries a risk of progression to esophageal cancer. In virtually every article, authors stress the importance of controlling reflux as a means of reducing the risk of Barrett’s and subsequent esophageal cancer. The natural assumption is that since acid causes the burning sensation it must also be the cause of Barrett’s and subsequently cancer. Treatment recommendations invariably include taking drugs to stop acid from being produced by the stomach. However, there is growing evidence that that assumption may not be entirely correct.

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Beginning in the early 1970’s a new type of acid suppressing medication, called Histamine-2 Antagonists (H2 Blockers) was introduced. The first of these drugs was Tagamet®, but is was soon followed by Zantac®, Pepcid®, and Axid®. These medications rapidly became among the most widely prescribed drugs in America, because unlike common antacids, (Tums®, Rolaids®, Maalox®, etc.) they could be taken as a once a day pill and they offered patients prolonged relief from troublesome heartburn. The H2 Blockers were joined by new category of drugs called Proton Pump Inhibitors, or PPIs, when Prilosec® came on the market in 1989. Other PPIs, including PrevAcid®, Nexium®, and Protonix®, followed by Aciphex®, Dexilant®, and Kapidex® are now among the most commonly prescribed medications, accounting for more that $12 Billion in sales annually. Many are now also available over-the-counter.

So what is the relationship between acid reflux and Barrett’s esophagus? If acid exposure causes Barrett’s and subsequently cancer, given the effectiveness of acid suppressing medications, and the millions of people who are taking them regularly, we should be seeing far fewer cases. However, the opposite is true. The incidence of esophageal cancer is rising faster than any other type of malignancy in the United States. (See Chart Below)

Cancer Growth Chart

While there is no definitive scientific evidence linking any of these medication to the growing numbers of patients with esophageal cancer, the graph below demonstrates very clearly that the alarming trend began in the mid 1970s, shortly after Tagamet came on the market. At the very least, this raises the question whether the chronic reflux of non-acidic stomach fluid might play a significant role in the development of Barrett’s and subsequent esophageal cancer. Clearly more research is needed to establish any such relationship.

Meanwhile, it is clear that medications offer excellent heartburn relief for most patients without eliminating or even reducing the mechanical reflux of stomach contents into the esophagus. To actually stop reflux requires a mechanical solution. Several minimally invasive techniques are available which are designed to augment the function of the lower esophageal sphincter and effectively stop reflux. Certainly not every heartburn sufferer is a candidate for surgery, but for those who are these procedures can help them avoid a lifetime of medication while potentially reducing their risk of developing Barrett’s esophagus and esophageal cancer.

 

 

North Texas Heartburn and Reflux Center is responsible for the content of this article. For more information contact their Southlake, Texas office at 817-749-0206 or go to www.myrefluxisgone.com.

 

 

5 Year data on the effectiveness of the LINX® Reflux Management System

linx-spin-frame-1The LINX® Magnetic Device

The LINX® Reflux Management System has been around for nearly a decade, and was approved by the FDA for implantation for the treatment os Gastroesophageal Reflux Disease, GERD, more than 4 years ago, yet most of the nearly 60 million people who suffer with symptoms of GERD have never heard of this option to a lifetime of medical treatment. Click on the photo or the link below to read an article which appeared on FOX News Health almost one year ago.

The LINX device (pictured here) is implanted at the bottom of the esophagus to strengthen the lower esophageal sphincter, which is weak in gastroesophageal reflux disease (GERD) patients.

We have been offering the LINX® Reflux Management System to our patients at the North Texas Heartburn and Reflux Center for more than 4 years with remarkable results. Call us at 817-749-0206 or check out or website at www.myrefluxisgone.com