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Down the Pipes

The Connection Between Acid Reflux and Barrett's Esophagus

Heartburn, heartburn, and more heartburn. What a miserable cycle. One minute you’re fine, enjoying a light evening meal with friends. The next thing you know, you feel awful. Heartburn rears its ugly head - the burning begins, the tightness, the pain in your lower chest area. Here you go again, and these days it seems not to matter what you eat, nothing is safe. You grab the antacids you never leave home without, and it helps a little, but your evening with friends is shot. 

Heartburn, or acid reflux, is caused by stomach acid flowing up in the food pipe, or esophagus. Most of us experience acid reflux from time to time, but if it’s chronic, we may have been diagnosed with GERD (Gastroesophageal reflux disease). 

“When acid from the stomach refluxes up into the esophagus, it irritates the inner lining of the esophagus,” says Prashant Krishnan, MD, gastroenterologist with Peak Gastroenterologist Associates and GI Section Chair with Memorial/UC Health. “The stomach produces hydrochloric acid. Due to certain barriers and mechanisms, the stomach is usually not damaged by this acid.”

Dr. Krishnan says the esophagus, however, doesn’t enjoy this same protection and is susceptible to damage if acid refluxes up. If the irritation continues, a potentially dangerous condition known as Barrett’s esophagus can develop.

“Over time,” says Dr. Krishnan, “the esophagus adapts to this constant irritation by replacing normal squamous cells with intestinal cells, since intestinal cells are more resistant to hydrochloric acid. Adapting to its environment sounds like a good thing for the esophagus; in fact, intestinal cells have a higher risk of transforming into cancer cells, increasing your risk of developing esophageal cancer.”

Barrett’s esophagus occurs where there is more exposure to acid, says Dr. Krishnan, “typically in the lowest part of the esophagus. It is rare to see Barrett’s in the upper part of the esophagus, so throat cancer is less likely.”

Risk factors for Barrett’s esophagus include smoking, age, gender, ethnicity, and lifestyle. “Middle-aged and older adults are at higher risk than younger individuals. Men are at a higher risk than women. Caucasians are at higher risk than Hispanics, Asians, or African-Americans.”

And of course long-standing reflux symptoms like heartburn increase our risk for Barrett’s.

“If you have uncontrolled or long-standing symptoms of acid reflux,” says Dr. Krishnan, “see a gastroenterologist about getting screened for Barrett’s esophagus.”

Dr. Krishnan says there are things we can do to minimize reflux, such as decreasing consumption of chocolate, peppermint, coffee and tea, alcohol, and fatty foods. “Do not eat meals before going to bed, and do not lie down immediately after eating,” he says. “If you smoke, stop! There are plenty of reasons to give up smoking; add this to the list. If you have heartburn, you may need to take medications to eliminate the reflux.”

So how do we know if we might have Barrett’s since the condition itself can be symptomless?

The only way to find out if you have Barrett’s esophagus, says Krishnan, is a procedure that provides a direct look at the esophagus, known as an upper endoscopy, or esophagogastroduodenoscopy (EGD). “With these scopes,” says Dr. Krishnan, “a gastroenterologist uses a camera and a light to see the inside of the esophagus and to visualize the abnormal lining. We can take biopsies of these abnormal areas and have a pathologist look at the cells under a microscope to confirm whether a patient has Barrett’s.”

Treatment options can include some combination of strong acid reflux medications, the use of proton pump inhibitors to reduce the production of gastric acid, and endoscopic procedures that involve removing damaged tissue.

If you’re one of those people who experiences frequent bouts of heartburn and have for some time, it’s important to get checked out on a regular basis. Even if Barrett’s esophagus is diagnosed, says Dr. Krishnan, there are many things that can be done to minimize the risk of ever developing esophageal cancer. 

 “A great resource is to talk with a gastroenterologist who can tailor recommendations to your needs,” he says.

Did you know …

60% of US adults will experience some type of GERD in a 12-month period and 20-30% will have weekly symptoms.
Approximately 7 million people in the US have some symptoms of GERD. 
Those reporting weekly reflux symptoms have been affected by the symptoms for more than 5 years.
50% of all people questioned reported that they have more heartburn at night than in the day. 63% reported difficulty sleeping and 40% reported compromised functioning the following day.
Approximately 1% of all people in the US with a diagnosis of GERD also have Barrett's esophagus. 
The average age of diagnosis for Barrett's esophagus is 50.
Some studies suggest a possible connection between stress and acid reflux.

(Source: Healthine.com - statistics years vary)