Am I on the fast track to esophageal cancer?

October 24, 2012 3:07 PM

I have had acid reflux for about a year which is mostly controlled via Zantac but still flares up occasionally. It's basically okay, but I've now realized that it's something I'll have to live with. How worried should I be about getting esophageal damage or cancer?

I am 22, pretty young for this sort of thing.

My symptoms are heartburn, a tight feeling in the chest, and frequent hiccups. Sometimes I feel like air is caught in my throat. I will be fine for month-long stretches (as long as I take my medication) and then it will flare up for a week or two. If I don't take my medication, things get bad again.

I take Zantac (ranitidine) 150 mg twice a day, and Gaviscon as needed if things flared up.

I have experimented with diets and not really found a connection. I still eat many "bad foods" such as oranges and tomatoes because they do not seem to cause any problems for me. The only things I now avoid are beer, plain coffee and Coke.

When this first happened I went to a doctor and was given a spectrum of blood tests including a check for celiac and h. pylori (both negative). I have never had an endoscopy because my doctor did not find it necessary.

I have not been seeing a doctor since because I found them extremely unhelpful - I went to three doctors and they all pushed PPI drugs on me despite me saying that I didn't want them. I had tried both Tecta and Nexium and they made me much worse with horrible bloating, stomach pains and feeling constantly full. (I'm also worried about PPI since they reduce iron absorption and I have struggled with anemia due to heavy menstruation.) I have not had any side effects with Zantac. However, doctors have told me that the PPI drugs are much better and there is no reason why I should have had these side effects.

I feel like I am doing an OK job of managing my reflux on my own with Zantac, and I've gotten used to the occasional flare-ups. I'm still worried about getting Barrett's esophagus or cancer, though. (It doesn't help that I have a MAJOR history of health anxiety.)

How worried should I be after a year of heartburn symptoms? Like, is there a chance I could have cancer already?
When do I need to see a doctor and get an endoscopy?

Also: has anyone had any luck with any 'natural' remedies for reflux, like papaya enzyme or probiotics? I tried apple cider vinegar but it didn't seem to do much at all.

posted by anonymous to health & fitness (25 answers total)

You most certainly will not get cancer from having acid reflux for a year. EVEN IF your acid reflux played a role in you getting cancer, it would be after many decades. Keep in mind that it's just a risk factor for esophageal cancer - it doesn't 'cause' cancer.

Also, esophageal cancer is painful. Your throat would be sore, it would be difficult to swallow, you could be bleeding in your throat.

What you need is to talk to a therapist about your health anxiety. That will help you so, so much more than an endoscopy.
posted by Lutoslawski at 3:19 PM on October 24, 2012 [1 favorite]

I had waited a fairly long time to get my first colonoscopy. When I told my doctor that I had reflux from time to time, she said i needed endoscopy. They did remove a few polyps and now, a few years later I get this regularly. I also take purple pill--Nexium--to reduce tummny acids. Coffee and tomato tend to invoke reflux, esp if in evening close to bed time...There is a recent paper suggesting that Nexium ought to be taken with some care and not often for the acids in the tummy are there for a purpose...What I now do is to take the pill every other day unless it is Pizza day, in which cawse I will take it.
posted by Postroad at 3:20 PM on October 24, 2012 [1 favorite]

Sounds like you've burned up the natural flora in your stomach/upper GI tract. Take some acidophilus or some probiotic yogurt.

I burned mine up in my late teens early twenties as a result of stress, liquor, coffee etc. and I ended up with ulcers. (My symptoms started exactly as yours have.) At the behest of an aging hippie/guru I slammed a ton of acidophilus, wiki about it, and that completely solved the problem.

I still dose up on it every couple of years as needed. Good luck!
posted by snsranch at 3:26 PM on October 24, 2012 [9 favorites]

Do not be too worried about this issue. There are many people having this issue but do not caught by cancer.
posted by onkyo at 3:30 PM on October 24, 2012

What types of doctors have you seen? Sounds like you need a gastroenterologist. If by any chance you are in the Bay Area, MeMail me for a recommendation.

I agree that you would probably benefit from some types of probiotics. My gastroenterologist's breakfast recommendation is organic probiotic yogurt (not sure why organic, I need to ask him next time I go in) topped with berries and low-fat granola.

I agree that talking to someone about your health anxiety would probably be helpful. Also anxiety can make your tummy problems worse!
posted by radioamy at 3:34 PM on October 24, 2012 [1 favorite]

There is almost zero chance you have caused enough damage to change your risk factors for cancer.

But you should get the reflux under control. One thing to watch for is that some of the foods you eat don't have instant effects on reflux. I can have the occasional cup of coffee and have no problems. But if I drink it for a couple of days straight, it's a sure fire reflux attack. Same with cigarettes. The only thing that causes instant reflux for me is onions.
posted by gjc at 3:36 PM on October 24, 2012 [1 favorite]

To gjc: For me, instant cause for reflux is pop, a cup of water after a meal, and the very late cup of water before bedtime.

All of these are liquids. So be aware of liquids, too.
posted by onkyo at 3:41 PM on October 24, 2012

radioamy and gjc bring up great points. Anxiety was definitely one of my problems and since then I've quit tobacco, coffee and anything that has introduced (as in not naturally occurring) citric acid. It's amazing how many things have citric acid added to produce "tanginess". Lactic acid too. Milk and cheese.

FWIW, MDs didn't help me at all. They did an upper GI (scope) let me know that I had really awesome ulcers and prescribed TAGAMET. Just like everything that is pharmaceutical and prescribed today, it masks the symtoms and does nothing for the actual cause.
posted by snsranch at 3:49 PM on October 24, 2012

I was in a similar situation. I took Prevacid and Nexium for a while.

Then I read that back in the day when they were prescription only, they were among the most prescribed drugs in the country. Doctors gave it to babies even. And I wasn't seeing much improvement with it. So I stopped.

I manage it now with antacids. I sleep on my left side, which is supposed to help. Doctors can test whether your esophagus is having issues but it's pretty unlikely. I think most people who get esophageal cancer smoked or drank a lot. And it's not an especially sneaky cancer. I wouldn't worry.
posted by kat518 at 4:00 PM on October 24, 2012

A spoonful of raw honey and a little bit of raw garlic, 1-3 meals per day does something magical to my digestion (previous had acid burps and a bit of LPR). Perhaps the antibiotic nature of both.
posted by zeek321 at 4:33 PM on October 24, 2012

I had near-constant excruciating heartburn, and ended up taking over-the-counter reflux medicine for years and years. I tried limiting all the traditional foods and dropped about 70 pounds, and nothing helped.

When I drastically cut sugar, wheat, and vegetable oils out of my diet a year and a half ago, the reflux went away completely.
posted by sudama at 4:53 PM on October 24, 2012

Cancer is a long term risk of reflux or GERD, not something you will get at 22. However, the air caught in throat symptom sounds very much like you may have scar tissue closing off your esophagus, which just exacerbates the symptoms. When they scoped me they found my esophagus was 90% blocked. I finally went to a Gastro because I was choking when I tried to eat. Then again, I waited until I was 40 to deal with it. Don't do that.

I gave up coffee, cut way back on dairy, and take 40 mg of Omneprazole daily and I'm 99% symptom free.
posted by COD at 4:58 PM on October 24, 2012

Try "sweetening" your stomach with Activia. A helping of it before a meal helps many people with acid reflux. Also try eating smaller meals. Light meals and neutral snacks might be better for you. For a while, avoid coffee, alcohol, citrus fruit, all the things that make life worth living - even chocolate alas - and see if you do better.
posted by Cranberry at 5:00 PM on October 24, 2012

Mark Bittman talks in this NYTimes article about having GERD from his teens, and about various natural remedies he tried (that didn't work) until he found one thing that did (giving up dairy).
posted by lulu68 at 5:10 PM on October 24, 2012

they all pushed PPI drugs on me despite me saying that I didn't want them. I had tried both Tecta and Nexium and they made me much worse with horrible bloating, stomach pains and feeling constantly full.

FWIW I've been on and off PPIs for several years (ulcers, gastritis/dyspepsia). At first I was on raberprazole and didn't notice any side effects because I was miserable and on other drugs to boot. But when (after nearly a year) one doc doubled my dose, I really noticed the side effects you describe. He immediately switched me over to Nexium and I had less, but was still miserable with the side effects (a different flavour of nausea, if that makes sense). He told me to persist with it for a month and, almost a month to the day, the side effects from the Nexium disappeared.

I was later shifted back to raberprazole and the SEs returned and stayed until I switched back to Nexium (then a very short spell of SEs but little to complain of). Back to raberprazole another time, and was again miserable with SEs until I quit.

Doc#1 insisted there couldn't be any difference between PPIs, but my experience says otherwise. So IME not all PPIs are the same and one may work for you if you can sweat it out for a month or so.
posted by K.P. at 5:37 PM on October 24, 2012

Seems like you're worrying unnecessarily.

My dad died of esophageal cancer at age 59 that doctors suspect was caused in part by chronic untreated heartburn he'd had as a young boy. (He didn't see a doctor probably until his late teens, and probably not very often after, he grew up in foster care. Seems pretty different than your experience of treating your heartburn and I'm assuming getting regular checkups.) So yeah, it can be a cause but what doesn't cause cancer these days? Who knows what perfect storm of things caused my dad's? The anxiety is definitely doing you harm, though! So I'd just make sure your doctors going forward are aware of your heartburn and do what you can do to stay happy and healthy.

One note. While worrying about getting cancer is pretty useless, IMO, if my dad had been more aware of his risk maybe the doctor could have caught it before it was already stage 4. I'm not saying this so you worry more, but rather so you'll rest easier knowing that you are already aware of whatever slight risk you have and can stay on top of it.
posted by thesocietyfor at 6:11 PM on October 24, 2012

No, I don't think you have cancer, but yes, I think you should see a gastroenterologist and get an endoscopy if you have an affordable way to do so. There may be causes that they can't determine just from a list of symptoms. If you've seen multiple doctors without any results, it is probably time to investigate further with a specialist.

I just went through my own serious acid reflux issues (severe abdominal pain and vomiting, especially at night) that were greatly improved by seeing a GE and making changes to my diet. After my first scope they were worried that I had Barrett's Esophagus, which can greatly increase your risk of cancer down the line. You may want to have your GE see if this is something that you need to worry about because once the damage is done it's irreversible. I'm not trying to scare you, but mostly just encouraging you to follow up because acid reflux can wreak all kinds of havoc on your esophagus and digestive tract.

I went on a strict acid reflux diet for three months and noticed a big improvement. I stopped drinking anything caffeinated, carbonated, and/or alcoholic. I also stopped eating fried foods, red meat, anything fatty, anything really spicy, and tomato-based sauces. No citrus, no chocolate, no fatty dairy. Eat dinner at least three hours before you want to go to bed. As someone mentioned upthread, I also started out sleeping on my left side because that's the way your stomach drains. I'll roll over when I wake up after a couple of hours. You can also raise the head of your bed by 6-8 inches and that will help too. Don't sleep with more pillows under your head though, though--that can put your body at an angle that might trap acid in your stomach.

I just did a follow up scope and almost all of the inflammation was gone and my stomach and I have been much happier. Doc says I can start adding some of these things back in because sometimes things that wouldn't normally bother you are a problem if your stomach/esophagus is already inflamed. So don't think you have to do this forever! I'm also taking ranitidine at night before I go to bed and omeprazole as needed, but I think the diet changes had the biggest impact.
posted by Colonel_Chappy at 7:26 PM on October 24, 2012

Seconding an endoscopy... I didn't even know I had reflux, no symptoms at all. Found out I have Barrett's esophagus a couple years ago, just got another endo and it has improved... been taking ranitidine.
This has scared the crap outa me.
posted by drhydro at 8:32 PM on October 24, 2012

Just for the record, while not really answering the main question: trying to avoid the traditional "bad" foods didn't do diddly squat for me, but eating low-carb did, the condition went away almost overnight. As in: cut sugar, flour, potatoes, eat most of the rest.
(I always thought, for example, that pork fat was rally bad for my stomach, kept me awake burping all night. No. It was the potatoes in combination with the pork fat. I can eat pork fat without carbs all day long and nothing bad happens).

I'd give it a shot of a few weeks, before making an appointment (which I would do otherwise...)
posted by Namlit at 11:02 PM on October 24, 2012

In my personal pursuit of trying to fix my own health woes, I came across Dr. Koufman's low-acid diet . She is considered possibly the world expert on laropharyngeal reflux (aka 'silent' reflux). While that's not what you have, couldn't hurt to try. Study here. (My problem appears to be gallbladder related, so it did nothing for me). YMMV.
posted by bitterkitten at 7:47 AM on October 25, 2012

I used to have terrible, volcanic heartburn that used to keep me up at night. It turns out mine was food allergy related (eosinophilic esophagitis) but I will say that I tried and was given a ton of acid blockers and ate whole containers of tums, tried every OTC heartburn and nothing helped significantly. Prilosec did help a little but not a lot.

Totally agree about the probiotics, and lots of them. Yogurt actually doesn't have that much probiotics in it, and unless you like eating lots of yogurt, I'd really recommend some kind of capsule supplement. Align and Pearls are great brands.

I also found that papaya enzymes (american health brand) worked much better than Tums for me, and I also drink Aloe Vera (without citric acid- Lakewood is the only brand, commonly found in health food stores) and found that helped the inflammation going on but YMMV.

Also, I don't know if this helps, but I used to be pretty anemic too. I really like the Bifera brand- a little pricey, but absorbs so much better. Iron also used to worse my heartburn, but this one didn't, so I was happy to find it.

Good luck! And I hope you feel better.
posted by Aliera at 7:47 AM on October 25, 2012

Oh and don't worry about cancer. You'd need to have GERD for decades before your risk increases significantly. There's always a nonzero risk for everyone, but there isn't really anything that can change that. Just keep on focusing on managing your heartburn and reducing your symptoms. You also might consider keeping a food/heartburn level food diary and see if there are any problem foods that consistently set off your heartburn.
posted by Aliera at 8:05 AM on October 25, 2012

I worry about esophageal cancer, too. It's what keeps me taking meds for it, frankly. But as others have said, it takes a long time to increase your risk, and the risk isn't as big as has been thought. Also, you're in luck because the risk is even lower in women.

I've had heartburn off and on (mostly on) since my teens. I've had an esophagraphy, a million tests for h. pylori, abdominal ultrasounds, etc. The doctors always just end up prescribing antacids. I took Zantac for over a decade and it was adequate to the task, with occasional breakthroughs. Eventually the maximum dose wasn't enough, though, and I very recently switched to Nexium. I had the same experience as you when I first tried it five years ago, and so went back to Zantac. This time, however, I started taking it only once or twice a week at first, and ramped up slowly to my current dosage which is taking it alternate days.

The only times I've managed to be drug-free and heartburn-free have been when I've been under care of naturopaths. That usually involves a very restricted diet and supplements including pro-biotics, digestive enzymes and DGL licorice. The three supplements without the restrictive diet work OK, but not as well, for obvious reasons.
posted by looli at 8:22 AM on October 25, 2012

I have acid reflux that came on when I was about forty, largely because of a hiatal hernia. One thing I have discovered over the subsequent years is that getting a bit overweight really seems to make it worse. Whenever I manage to maintain something close to my ideal weight I seem to get far fewer attacks and the ones I do get are far milder. Not sure if that's relevant to you, but it's something to bear in mind.
posted by Decani at 9:56 AM on October 25, 2012

I thought this paragraph from the AAFP Review on Esophageal Cancer might be helpful to you. There are two major types of esophageal cancer, squamous cell carcinoma and adenocarcinoma.

"In contrast to squamous cell carcinoma, it is unclear to what extent, if any, smoking and alcohol contribute to the development of esophageal adenocarcinoma. There is a proven association between adenocarcinoma and Barrett’s esophagus, a condition in which metaplastic columnar epithelium replaces normal stratified squamous mucosa that appears to arise in response to chronic inflammation from gastroesophageal ref lux disease (GERD).(6,8–10) In the United States, the rapidly growing problem of obesity has been shown to have a causal relationship to GERD, thus increasing the risk of developing esophageal adenocarcinoma.(7,11,12) Results from the 1999–2002 National Health and Nutrition Examination Survey indicate that about 65 percent of U.S. adults are overweight or obese.(13) This represents a 16 percent increase since 1994, paralleling a rise in the incidence of esophageal adenocarcinoma."

There is no "fast track" to esophageal cancer (adenocarcinoma) that results from the long term exposure of the cells in your lower esophagus to acid. As others have noted, it is a long process that occurs due to chronic exposure. The average age at diagnosis is 50 to 60 years old.

"Cessation of modifiable risk factors (e.g., smoking, excessive alcohol ingestion), appropriate treatment of premalignant conditions (e.g., GERD, achalasia, strictures), and aggressive monitoring may significantly improve morbidity and mortality associated with late diagnosis. Causal relationships between tobacco usage and gastrointestinal malignancies have been demonstrated for several decades, emphasizing the importance of smoking cessation strategies. Acid suppression with proton pump inhibitors and histamine receptor blockers are thought to indirectly reduce the incidence of esophageal cancer. A recent prospective study (26) concluded that the use of proton pump inhibitors after the diagnosis of Barrett’s esophagus was independently associated with a reduced risk of dysplasia." (the bolding is mine for emphasis)

"Dietary modifications seem to play a role in the reduction of cancers of the upper aerodigestive tract, suggesting a benefit from a diet high in fruits and vegetables. Scientists believe that fruits and vegetables contain high levels of phytochemicals that may modify carcinogenesis through their antioxidant properties, suppressing the abnormal proliferation of early, preneoplastic lesions.(27)"

You should decide whether the risks outweigh the benefits for you in taking PPIs in a discussion with your doctor. I personally think that others here are being too blase about your risk for cancer. Exposure to UV light is a risk factor for skin cancer, exposure to cigarettes is a risk factor for lung cancer, that doesn't mean everyone who gets a sunburn gets skin cancer or everyone who smokes gets lung cancer, but I think it is foolish to use this as a justification not to address a risk factor. Diet is important and I think it's good that you've been trying to address it. If you and your primary care physician cannot come to a good resolution giving you control of your GERD, ask for a referral to a gastroenterologist. That person is the best person to tell you when you need endoscopy. If you don't like your PCP, the answer is not avoiding the doctor and getting medical advice from the internet, it's getting a new PCP.

The worst/most dangerous advice above is that "esophageal cancer is painful and symptomatic and you would know if you had it, so don't worry." I agree that you should not worry that you have cancer now, that is so unlikely it's really not worth wasting mental energy on. But by the time you have symptoms of esophageal cancer, it's far too late and advanced which is why it has such a high mortality rate. That is why addressing prevention, screening and monitoring of treatment is so important. I am not saying this for you because as I said, I'm not concerned you have cancer, but I don't want others reading this to be falsely reassured by the misleading answer given above. IANYD and this is not medical advice.
posted by treehorn+bunny at 11:57 AM on October 25, 2012 [1 favorite]