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.

 

 

PPIs and Heart Disease

PPIsIf you are among the millions of people who take a PPI (Proton Pump Inhibitor) every day to prevent heartburn, you need to know about this study.

Common Acid Reflux Drugs Associated With Increased Risk for Heart Attacks – (read more)

 

For decades Americans been subjected to aggressive ad campaigns for the “little purple pill” and its relatives. Many PPIs are now available over-the-counter, and countless heartburn sufferers have come to depend on one or more of these powerful acid reducing medications to “put out the fire.”

PPIs OTCFor several years we’ve known about the link between PPIs and heart disease in patients taking Plavix®, a commonly prescribed medication to prevent blood clots, but the risk now appears to extend to a much broader group of patients. According to a recent study conducted by researchers at Houston Methodist and Stanford University, chronic use of PPIs increases the overall risk of heart attack (myocardial infarction) by 16-21% compared to patients who don’t take PPIs.  The exact mechanism is unknown, but scientists believe it is related to suppression of an enzyme called DDAH, which is essential for cardiovascular health.

When PPIs were first introduced they were recommended for short-term use only (a few weeks). However, because their near universal effectiveness in reducing stomach acid and heartburn, countless patients have continued to take them, often for many years. With the release of this study, and others linking PPIs to other significant medical problems, their routine unsupervised use is being questioned by doctors and patients alike.

If you are concerned about the risks of taking PPIs, but just can’t imagine how you could get through the day without your heartburn medication, it is time to learn about your alternatives. In addition to H2 Blockers, like Tagomet®, Zantac®, Pepcid®, and Axid® there are minimally invasive surgical techniques, which treat reflux disease at its source, often eliminating the need for medication entirely.

To learn more about how to “put out the fire – permanently” go to www.myrefluxisgone.com.