You’re probably familiar with the sensation of heartburn. Almost everyone will experience this burning in the chest and sour taste in the throat at least once in their lifetime. It’s caused by acid reflux, or stomach acid splashing backward into your esophagus.
For most people, occasional heartburn is minor and can be treated with over-the-counter medicines. But if you notice that you’re experiencing heartburn regularly, you need to talk to your doctor. You may have gastroesophageal reflux disease (GERD), which puts you at increased risk for complications, including one called Barrett’s esophagus, which may affect as many as 15 percent of people with ongoing reflux.
“Barrett’s esophagus is a precancerous condition of the esophagus, which happens in some people with acid reflux after a long period of time,” says UNC Health gastroenterologist Nicholas Shaheen, MD, MPH.
Not everyone with Barrett’s esophagus will get esophageal cancer, but if you are diagnosed with Barrett’s esophagus, you’ll need special monitoring so that cancerous changes can be detected as early as possible.
“People think reflux is very normal, so they’ll just reach for Mylanta and not pay attention,” Dr. Shaheen says. “When you ignore the symptoms, you miss out on this time that we could have watched and intervened before the changes continued or became cancer.”
How Barrett’s Esophagus Develops
If acid reflux happens every once in a while, it’s annoying and painful, but there’s usually no long-term damage. More frequent acid can damage the esophageal lining.
“If you have acid reflux a lot, the lining of your esophagus changes to a lining that is thicker,” Dr. Shaheen says. “That thicker lining, Barrett’s esophagus, is better at resisting acid, which is good, but the bad part is that those changes can degrade into cancer for a small percentage of people.”
Doctors think it takes years of frequent acid reflux to cause these changes, so you don’t need to worry about the results of one decadent meal. And not everyone who has persistent acid reflux will get Barrett’s esophagus; there is also likely a genetic component.
“It really varies person to person, but if you’re having reflux or heartburn several times in a week or a month, mention that to your doctor,” Dr. Shaheen says. “If you continue to have symptoms for a few years, you should be checked for Barrett’s.”
It’s especially important to mention frequent heartburn to your doctor if you have additional risk factors, which include being male, white, older than 50, obesity, smoking or a family history of esophageal cancer or Barrett’s esophagus.
Barrett’s esophagus is diagnosed with an upper endoscopy. During this test, your doctor guides a small, flexible camera down your throat to look at your esophagus and stomach. If your doctor sees changes in your esophageal lining, they can take small biopsies to look for cancerous cells. Most people opt for sedation that puts them to sleep during the procedure.
Living with Barrett’s Esophagus
Once Barrett’s esophagus is diagnosed, you’ll need regular endoscopies to monitor for changes.
“If the biopsies show Barrett’s but no dysplasia (precancerous changes), then you’d have an endoscopy every three to five years,” Dr. Shaheen says. “You’ll also be put on acid suppression medication, probably for the rest of your life, to decrease the amount of acid reflux.”
Lifestyle changes such as losing weight, avoiding foods that trigger your heartburn and not eating late at night can help with how often you experience acid reflux, but once you have Barrett’s esophagus, it generally won’t go away on its own. That’s why it’s important to continue to follow up with your provider once Barrett’s has been identified.
“I tell people that you have to think about Barrett’s esophagus like high blood pressure or diabetes,” Dr. Shaheen says. “It’s something you have to take care of and monitor to make sure it’s not evolving. It won’t get worse overnight, but to ignore it entirely is bad.”
If one of your endoscopic biopsies shows dysplasia, your doctor may recommend another endoscopic procedure to burn or freeze those precancerous cells. This procedure can cause slight pain and discomfort under the breastbone that tends to ease in a few days.
“For most people, the dysplasia doesn’t come back, but for about 8 percent of people each year, it does, so you still need to be monitored,” Dr. Shaheen says.
Finding the dysplasia early means you can avoid more invasive treatment for full-blown esophageal cancer, which includes surgery, chemotherapy and radiation. Less than 1 percent of people with Barrett’s esophagus develop esophageal cancer each year, but you do remain at higher risk than the general population.
While it can be overwhelming to know you’ll need regular endoscopies for the rest of your life, knowing you have Barrett’s esophagus gives you and your doctor the best opportunity to prevent esophageal cancer.
“Most people with heartburn don’t get Barrett’s esophagus, and most people with Barrett’s don’t get cancer, but a small group will,” Dr. Shaheen says. “If we identify the precancer through observation and intervene before cancer develops, we can reduce the number of people diagnosed with esophageal cancer. Talk to your primary care provider about chronic heartburn, because it might be something more.”
If you’re concerned about acid reflux or heartburn, talk to your doctor or find one near you.