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GETTING HEARTBURN OR acid reflux occasionally is fairly normal – but some people find themselves chronically affected by these ailments.
Some of those people could also have a condition that can have an even more serious impact on their health.
Up to 10% of people with chronic heartburn could be at risk of developing the condition known as Barrett’s oesophagus – about 4-5 per cent of people with Barrett’s will go on to develop cancer.
What it is
The Irish Society of Gastroenterology wants more people to know about the condition, which is where the cells lining the lower part of the oesophagus undergo change as a result of constant acid reflux from the stomach.
Barrett’s is considered a pre-cancerous condition, and endoscopic screening for it and for early pre-malignant changes is generally recommended in all adults aged 50 and over who have a long history (over five -10 years) of heartburn.
What the experts say
Prof Dermot O’Toole is an upper GI consultant gastroenterologist at St James’s Hospital and a member of the Irish Society of Gastroenterologists. He’s a leading consultant and expert on Barret’s oesophagus.
He spoke at the recent summer meeting held by the society, where the latest discoveries on Barrett’s were discussed.
Prof O’Toole pointed out that a lot of people get the odd bout of heartburn or reflux every now and again, and “this is normal”. It’s termed physiological reflux.
He pointed out that when changes are detected early, patients with Barrett’s can be entered into programmes where they are put under medical surveillance.
Keeping an eye on the condition
Under these programmes, they undergo an endoscopy every three to five years to monitor for any cancerous changes.
Prof O’Toole said that there may be an element of “overkill” in having everyone with the condition to have a scope, so it would be good to narrow down who would be most at risk of malignant cancer.
At the summer meeting, a number of free papers and research were presented that looked at the genetics of Barrett’s.
The experts were able to discuss whether genes may be useful in predicting patients who go on to experience malignant cancer with Barrett’s.
If work can be done in determining the patients with Barretts who are going to go on to eventually develop malignant cancer, this could mean targeting the screening at the at-risk group.
In the meantime, surveillance for all people with Barrett’s is still recommended.
Diagnosing patients
Some people who are diagnosed don’t have major symptoms of Barrett’s, but instead the condition is found when they have a scope for another reason.
“We are trying to better understand the genetics,” said Prof O’Toole, saying it may be helpful to look at disease modifying genes, and genes that show patients are predisposed to a more aggressive form of Barrett’s.
About 95% of patients with Barrett’s go on to die of unrelated causes.
Testing and treating Barrett’s
Currently, testing for Barrett’s involves a scope.
There is a new form of screening undergoing testing that sees the patient swallow a tablet on a string. Inside the tablet capsule is a small sponge.
After swallowing, the capsule dissolves and the sponge can be pulled back up, bringing with it some of the lining of the lower oesophagus.
This can then be analysed to make a diagnosis.
Treating cancer in Barrett’s patients also involves new technology. “If they go on to get early malignant changes or cancer, we now are capable of getting rid of that endoscopically,” said Prof O’Toole.
In the past, the treatment of early (‘non-invasive’) cancers in Barrett’s oesophagus was surgical removal of the oesophagus. These days we have minimally invasive procedures (endoscopic based) that can eradicate both pre-cancerous and early cancerous cells completely.
Weight and Barrett’s oesophagus
Weight plays a role in Barrett’s – as it does in many other physical conditions.
Reflux is common in Ireland, “especially in the Irish population where obesity is prevalent”, said Professor O’Toole. “There is a definite link between reflux and obesity.”
“We have a high degree of prevalence in our society of obesity or overweight,” he said. The national registry shows that 70 per cent of patients with Barrett’s are either overweight or obese.
Prof O’Toole encourages patients to get down to a normal body weight and make sure they eat quality fruit and fibre. He pointed out that vegetables and fruit have anti-oxidants, so help to introduce protective elements into people’s diets.
Patients are given treatments to suppress their acid production, whether they have symptoms or not.
People are encouraged to make lifestyle modifications alongside taking their medication, and avoid food and beverages that trigger acid production.
At the summer meeting, the gastroenterologists discussed the incidence of Barrett’s in America, and how incidence rates are in perfect correlation to obesity rates.
If you are concerned that you may have Barrett’s, you’re encouraged to speak to your GP.
People with chronic reflux who are on medication but have difficulty controlling their symptoms, and who have not had an endoscopy can speak to their GP about referral for specialist assessment.
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I was diagnosed with oesophageal cancer when I was 32, was not a smoker or heavy drinker and have never been overweight. I am really lucky to be still here – I had 3 months of chemo and then a total oesophagectomy and still can not eat a lot and get dumping syndrome etc. I am lucky to be alive though as it has a very high mortality rate (I was told that I had an 8% chance to get to 5 years). I am now 40 and mother to a 4 and 3 year old. If you have symptoms as mentioned in the article get them checked out. I had problems with food sticking and eventually someone listened and gave me a scope and it was diagnosed. I do have a good life but people should be vigilant.
Best of luck aoife.
Good advice Aoife.. Glad things are good for you and long may it last.. Xxx
I got diagnosed with Barrett’s at 21 after months of vomiting constantly and crying because my heartburn was so bad.. Swallowing the string sounds great compared to the camera,I can’t handle that it’s horrible…
Hi Ash,
I suffered from the precursor to this which is GERD. I stumbled upon a site which was not endorsed by any product that was essentially a bunch of people posting about how organic apple cider vinegar cured them of this. The same people were told by their GPs that they needed PPIs (Proton Pump Inhibitors) which are essentially very strong antacids (some were perpetually prescribed these drugs) – I had a 30 day course. After the 30 days the burning came back and I thought I was about to go through that hell again (virtually no sleep, vomiting, severe pain, overheating).
For anybody who suffers this or any form of heartburn I cannot recommend organic apple cider vinegar enough. It is inexpensive, safe and not bad tasting (depending on your tastes). Some people mixed a couple of tablespoons with water and drank in the morning. I just drank a few tablespoons straight and it has allowed me to eat the things that would trigger the reflux (sugar, tomatoes etc.).
A note on foods / things that are good and bad for sufferers. A high alkaline based diet is great. Certain citrus fruits (like limes) alkalize when they are ingested so they are good also. Sugar is bad. Tomatoes are bad – especially in concentrated form. Mint is bad (this was a surprise to me but it is definitely the case – certainly in tea form). Excessive water / fluids on an empty stomach is bad – try to eat regularly and not skip meals. Coffee or drinks high in caffeine are bad. Effervescent tablets are very bad. Sugar kills off your gut flora and also creates acid so try to lay off sugary things.
Let me see if I got this (bear with me here folks) – 4-5% of people with Barrets go on to develop cancer, but 95% DIE of something other than oesophageal cancer ( or, if you prefer, 5% die of it).
So if your Barrets leads to cancer, the chances are between 100 and 120% that it will kill you?
Jim barretts syndrome leads to a type of cancer called oesophageal adenocarcoma, which is a particularly nasty cancer. My father died of this form of cancer and the shocking thing is that it’s a cancer that over the past 50 years has been on the increase. It’s where the acid sloshing up your oesophagus starts to damage the layers of of cells of the oesophagus, the body replaces these cells with cells like what your stomach is lined with and these cells lead to cancer. The link with barretts has been made and it’s a clear link but there are a lot of patients who don’t have symptomatic barretts ( heartburn ) but develop it anyway. My father never sufferer hugely with heartburn but he often felt food repeating on him and occasionally had difficulty with swallowing, food getting “stuck ” that symptom became a everyday symptom and only then went to the doctor, after a scope he was diagnosed with this cancer.
This cancer is preventable largely and if caught early patients like Aoife survive but the treatment for well established disease is radical and in my fathers case fatal. It’s good that they have developed an noninvasive screen for barretts, but I think larger awareness of how you feel after eating is very important
I’m sorry to hear about your dad Kevin.
I just didn’t understand the statistics as they are presented in the article. They don’t seem to add up.
Hi Kevin.. My brother died of the same cancer in his 40′s not so long ago.. But again it was caught too late.. He had been to the doctor who fobbed him off.. A few days later food got stuck and he went to the ER.. He was a drinker, smoker and overweight and suffered heartburn for years. The sad part is he used beat himself up that it was his own fault he was sick and he was sorry he took his health for granted..
I dont its all related to lifestyle though cos when he was in his 20′s and lived a healthier lifestyle he would’ve suffered from heartburn..
Jim I think you may have what’s known as Bradys Oesophagus…. results in sufferers regurgitating absolutely senseless shite. 100 – 120% of sufferers are arse holes if my stats are right.
I know this condition can happen in younger people too. People suffering from Bulimia are particularly at risk.
I had oesphagus cancer 7 years ago.my operation was done by professor Kevin Conlon at Tallagh hosp.Hes an excellent surgeon and the operation was very successful.i also had chemo and radium to shrink the tumour first.my symptoms was just a little drop of blood came up my stomach nothing else,I followed it up and that was my diagnosis.
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