A study published by the University of Pittsburgh in the current issue of Archives of Surgery suggests that patients with mild or no symptoms of GERD may be at a higher risk for developing esophageal cancer.
This pronouncement is worrisome since all GERD patients strive to be either symptoms-free or with as few symptoms as possible. In fact, a mark of successfully living with GERD is to have symptoms under control (a.k.a. no symptoms). So, do we as GERD patients need to worry?
The main point of this study is that patients with severe GERD symptoms are screened for Barrett's esophagus, but those with mild or no symptoms are not. Dr Blair A. Jobe, professor and director of esophageal research and esophageal diagnostics and therapeutic endoscopy, Department of Cardiothoracic Surgery, Pitt School of Medicine stated: "Many patients who develop adenocarcinoma don't know that they have Barrett's esophagus until it has transformed into cancer and become advanced, leading to obstruction."
The study included 769 GERD patients who presented for their first upper endoscopy to look for tissue changes. The patients were divided into three groups: patients who were referred for upper endoscopy for any clinical indication regardless of symptoms; patients with typical GERD symptoms, such as heartburn, regurgitation and difficulty swallowing; and patients with atypical GERD symptoms, such as hoarseness, throat-clearing, mucus, coughing and a lump sensation in the throat. The patients underwent endoscopy and completed questionnaires and a detailed medication history. Endoscopy revealed that 122 of these patients, or 15.9 percent, had Barrett's esophagus or adenocarcinoma. Patients who were adequately managing their GERD symptoms with proton pump inhibitors (PPIs) were 61 percent more likely to have Barrett's esophagus or adenocarcinoma if they reported no severe GERD symptoms, compared to patients taking PPIs who reported severe symptoms.
While this may be a matter of concern, it should be remembered that this study included a relatively small number of participants, compared to the millions of GERD patients. Perhaps future studies which include larger groups of patients will back up this study. If thousands, instead of hundreds, of patients are studied, the percentages may different. But this study does bring up am important point. It may be a good to be screened for Barrett's esophagus even if a person has little or no symptoms. Dr. Jobe stated this:
"Our research indicates that even patients without severe symptoms may benefit from Barrett's esophagus screening," Dr. Jobe noted. "If GERD patients are screened early enough, there is a better chance that Barrett's esophagus can be identified before it becomes cancerous," he stated. "We are learning that the chronic and long-term use of PPIs may not be entirely without consequences and may lead to more insidious problems such as calcium malabsorption or cause one to be asymptomatic in the face of continued esophageal injury from GERD."
- Barrett's Esophagus
- Treating Barrett's Esophagus
- Esophageal Cancer
- Symptoms of Esophageal Cancer
- Treating Esophageal Cancer