When Heartburn Becomes Cancer
Heartburn may seem inconsequential, but it could signal a much bigger problem.
For most people, heartburn is a fleeting annoyance that can be solved by popping an antacid. And for a while, that’s what Jay Rensberger did. But when his heartburn became less of a temporary problem and more of a lifestyle issue, his wife took action.
“My wife got tired of me getting up in the middle of the night with heartburn and made an appointment with my doctor,” says Rensberger, a 49-year-old park services worker in Indiana. “He put me on medicine, which helped, but once I stopped the medicine the heartburn came right back.”
With his heartburn getting worse, he was referred for an endoscopy – a procedure in which a doctor snakes a thin camera down the esophagus and into the upper gastrointestinal tract to look for ulcers, inflammation of the stomach lining or other issues. Patients are typically put into twilight sedation, but not completely under, says Michael Sprang, an assistant professor in the division of gastroenterology at Loyola Medicine in Illinois. “You’re very groggy, but can listen and respond to commands,” he says. “Sometimes the doctor will ask you to help swallow the camera.”
The endoscopy showed irregularities in Rensberger's esophagus, and when his doctors performed another, he got a shock: esophageal cancer. “I thought I just had heartburn," Rensberger says. "I never thought the results would come back as cancer.”
For reasons not completely understood, esophageal cancer is on the rise, and is three to four times likelier to strike men than women, with 14,660 new cases expected in men this year, versus 3,510 in women, according to the American Cancer Society. Tobacco use and poor diet are major risk factors for esophageal cancer. The prognosis can be good if the disease is caught early, but early detection is rare because symptoms can be so general – heartburn and trouble swallowing are usually the only warning signs, leaving the average five-year survival rate at just 20 percent.
Rensberger was lucky – his cancer was caught early, but it meant going in for surgery immediately at the Indiana University Melvin and Bren Simon Cancer Center. “They removed my esophagus and 25 percent of my stomach,” he says. “Now I have to really watch what I eat, and I can’t eat after 6 p.m."
While the incidence of esophageal cancer is climbing – a 2009 study published in the journal Gastrointestinal Cancer Research estimates that by 2025, the number of cases will spike by 140 percent – that doesn't necessarily mean the millions of Americans who suffer from heartburn need an endoscopy, Sprang says. Routine endoscopies haven’t been shown to increase the detection of esophageal cancer, which is why Sprang believes the procedure should only be used when there's reason to suspect a more sinister culprit than heartburn is at play. In addition to heartburn, “there are a few [symptoms] that would trigger an endoscopy, like weight loss, trouble swallowing, vomiting or anemia," he says. " I also recommend one for men over the age of 50 who have chronic symptoms, because they have an increased risk for Barrett’s esophagus, which is a precancerous condition caused by acid reflux.”
So if your only symptom is heartburn, Sprang recommends you first start by changing your diet – cut out spicy or acidic foods, coffee and alcohol. Try an antacid or an over-the-counter proton pump inhibitor, designed to reduce stomach acid, to see if that helps. If, after all that, you are still experiencing symptoms or they're getting worse, your doctor might recommend an endoscopy.
But if an endoscopy with sedation worries you, there is another option, says Jamie Koufman, a professor of clinical otolaryngology and adjunct associate surgeon at the New York Eye and Ear Infirmary of Mount Sinai. It’s called a transnasal esophagoscopy, and it’s a good diagnostic procedure for people suffering from heartburn, Koufman says. “With TNE, there’s just local [numbing medication], and the tube is in you for less than five minutes.”
That’s not to say endoscopies aren’t necessary, Koufman says. “If you have a chronic cough, frequent throat clearing or a lump in your throat that won’t go away, an endoscopy is the right choice,” she says. “But if all you have is heartburn, you might want to opt for a TNE.”
Regardless which procedure you choose, the important thing is to not ignore your symptoms, Rensberger says, especially if you’re a man. “As men, we tend to put things off,” he says. “We try to be macho and deny that anything is wrong. I blamed my heartburn on stress, and it could have killed me.”