I am not sure that your comment is a completely accurate characterization of the lifetime risk of developing esophageal cancers. I understand you are trying to place the issue in perspective, but I’m not sure it is the right perspective. Let me explain that.
I have Barretts, was diagnosed more than 5 years ago, and had reflux for at least 10 years prior to diagnosis. Like the author, I feel as though I have a target painted on me…she because like her father she also has GERD. Me, because I have Barretts, and have read all this data, whipsawing between panic and denial with every conflicting or encouraging new study. Let me tell you right now that this is no way to live.
Heck, for all we know, based on studies conducted on adrenergic response, serum cortisol levels, and inflammatory disease, sheer Stress (physiological stress induced or mediated by psychogenic factors) itself could be the underlying factor causing people to have all these cancers and even cardiac events…so should we really let ourselves get all worked up about outcomes which we may ultimately not be able to affect no matter what preventative measures we take? BTW, I dislike articles that can give people false hopes – it seems that despite a few instances being observed, actually reversing the effect of Barrett’s is extremely unlikely. Removing metaplastic or neoplastic tissues can probably lower or even sometimes remove the risk, but even that, is not clear or certain.
Unfortunately, the statistics reported in “medical news” often suggest that 1% PER YEAR is the relative risk. Ie, from reading this stat, one would think that a 40-year-old with Barretts, has a 50% chance of developing esophageal cancer by the age of 90. This creates a lot of fear in the lay community because a 40 year old might see that and do this math in their heads and think well there it is, I’m gonna die from esophageal cancer with the same likelihood as winning on a black bet at the Roulette table. They don’t like these “odds” – suddenly a total toss-up “heads or tails” is now “Life or death.”
Now, in reality, that is only the mathematical implication and does not reflect the real world outcomes. The way the data are collected, the mathematical lifetime risk is clearly exaggerated when applied to the general population, because very few patients fit that model. The 1%/year data is based only on the population of people with Barrets. Typically that population is much older…in the 50s or beyond at diagnosis. In fact the average age is about 55. Interestingly men are about twice as likely as women to develop Barretts and white men are about twice as likely as other men of other races to get it (there’s some white and male privilege for ya).
So it is an absolute, but also additive risk – every year with Barretts is a fresh 1% chance of developing esophageal cancer. (If 1% were indeed the rate – which is not certain). That would apply no matter who you are and what age you are at, at the time. In other words, the annual risk isn’t greater in year 6 than in year 20, its always 1%. However, because its additive, the lifetime risk CAN be calculated by multiplying the rate by the number of years the risk has existed, but then that ignores that the average Barretts patient is already eligible to join AARP when diagnosed. So that’s part of the issue. At 55, the average man in the US only has less than 22 years left to live anyway. Thus, a 40 year old diagnosed with Barrett’s has more than double the total risk profile as a 60 year old and that is true regardless of dysplastic grading.
Based on studies in Denmark, the annual risk is actually far lower, somewhere between 2 and 3 tenths of one percent per year. Outliers like the 40 year old were probably excluded from this data, although I haven’t read it so I don’t know that for sure.
However, and this cannot be stressed enough ….that is a totally different patient population than exists in the US. As the author noted, Americans are fat. We are likely the most obese of all Westerners, due nearly entirely to our poor diets. The risk for an American might very well be 1%/year. We don’t really know. What we DO know is that obesity, and GERD and HH are all risk factors, and Americans score higher/highest amongst all developed nations on those factors. But does this risk score correlate well to observed rates of EC and mortality from EC? No, to both of those things.
What we can look at is life expectancy rates for Barrett’s patients, and if we do that we don’t find any significant deviations from the general population data, which is encouraging. This implies that despite having a greatly elevated risk of EC, overall mortality from all causes is basically the same. This means that whether you have Barrett’s or don’t, whether you are 40 or 70, assuming the annual risk is 1%, something else is 99 times more likely to cause your death – and at around the same age as everyone else in your cohort. As a white male, the likeliest population to become Barrett’s patients, we already live shorter lives than our better halves, by almost 5 years. (Note to the social justice brigade, we must get to work post haste on this “Gender Longevity Gap”. Surely President Warren will sound the clarion call?)
So that’s good news, I think, for people like the author, and myself, who both live with the fear of succumbing to something that could easily be imagined or reasoned to be our personal genetic destiny.
I’ve had problems with reflux all my adult life, never suspect that it might be also some dirty cancerous stuff. I’m after geting rd of throat cancer and reading all stuff over internet. for example in a book describing mostly common cancer types p Do I Have Cancer, I know that my symptoms were so obvious and I could deal with this much earlier with lower cost… Don’t underestimate signs, your body is giving to you!
When I was younger, I ate a typical junk food laden diet. During that time I also had severe acid reflux.
I changed my diet, eliminating most junk food and cured meats. My acid reflux stopped entirely with this change in diet.
Occasionally since then I have eaten cured meat. Every time I have done this, I experienced severe acid re-flux, hence proving in my case that acid re-flux is due entirely to diet considerations. I no longer ever eat cured meat and mostly eat a vegetable base diet.
Hi Virginia, sorry to hear your GERD diagnosis. DGL has helped me with acid reflux.
I’m sorry for your loss my farther also died of this terrible cancer. He too was only just 62. I also have reflux and as terrible as it sounds I’m terrified the same fate is awaiting me. My Dad was my absolute everything and still a year on its hurts as much as the day he passed.
Right on Mike benzodiazepines are a culprit!
Thank you for the post, it’s as interesting as scary.
What about LPR and cancer.
I am taking cimetidine which really helps.
Is there anything else I should be doing
I was diagnosed with Barrett’s Esophagus in January 2017. I went on an anti-inflammation, low-acid diet after reading “The Acid Watcher Diet” by Dr. Jonathan Aviv. I also started exercising more regularly every week.
The book was mentioned in Jane Brody’s column in the New York Times:
I had an Endoscopy in April 2018 and another in April 2019. I do not have Barrett’s Esophagus anymore, the cells are all normal.
I notice some of the “authorities” quoted in this article have significant conflicts of interest that just might color their perceptions. People reading the article need to be aware of that.
For example, the MD downplaying PPI risks is extensively funded by several PPI manufacturers.
For folks worrying about developing Esoph Cancerit pays to reread what was said early on: only a tiny percentage of folks even with Barretts go on to cancer. Far far less those with GERD.
Faint consolation of you are that person, bu you are likely NOT that person
PPIS are possibly the greatest invention in medicine. Only an idiot/nutjob thinks there is a better alternative, beyond born with a normal stomach.
Should really look into the health benefits of taking a hydrochloric supplement. It sounds counterintuitive; adding acid to a system that’s already producing too much.. ..but, if it’s understood that the microbiome is coming into play, as well, a desperate lunge-like effect whereby the body is over compensating for too low of acid by producing too much.. and continually getting worn out via this, it may make sense to see how adding HCl to the system could help not only adjust for this, but also readjust the microbiome that is having such an effect on the digestive pH to begin with.
I also had GERD, Barret’s, and esophageal cancer.
However, because my gastroenterologist knew I was at high risk, he did an upper endoscopy every 6 months. As a result, he caught my cancer at a very early stage and removed it surgically. I did not need chemo or radiation. That was 18 years ago, still cancer free.
So yes, see your gastroenterologist on a regular basis, and ask for regular endosopies.
I’m very sorry for your loss. I also lost my mother to untreated GERD, except in her case, she was aspirating stomach acid at night and inhaling stomach gases that over time caused the destruction of her lungs. She was misdiagnosed with idiopathic pulmonary fibrosis because her pulmonologist couldn’t figure out a cause for the rampaging inflammation in her lungs. (My mother didn’t smoke, didn’t have a genetic history, didn’t have industrial exposure.) But my mother did have horrible reflux and a hiatal hernia. I am bitter to this day that her doctors did not treat the hernia and allowed her to suffer from a problem that could have been corrected, likely with life-saving results. Take care of yourself. D
I’m surprised there’s no mention in the article nor in the responses of the part played by use of benzodiazapines in all their flavors. Not long after starting to take half a Zanax before bed every night to induce sleep, I started to feel the effects of GERD and at one point lost my voice for a couple weeks since the acid had progressed up my esophagas to affect my larynx while sleeping. The benzos relax that sphincter separating the stomach from the esophagas allowing the acid to seep upward.
The severety of the voice problem went away over time, although I still occasionally have a rough voice, I suspect for this reason. I still habitually take a benzo analogue at night, etiozlam – available without prescription.
When investigating my voice problem (this occured nine or ten years ago) I discovered the relationship between benzo use and GERD. The relationship between benzos and GERD was known at the time so I’m surprised to not see it mentioned in this article with comments.
I am sorry for your loss, Caren. Thank you so much for writing this article. I suffer from GERD as well and have Barrett’s. This has been the most frustrating condition to manage especially as an adult and I am glad there are finally more in-depth discussions happening around acid reflux. I had been meaning to make an appointment with my gastro doctor and after reading your article this morning, I did just that.
This is a very good article. I lost my husband 5 months ago due to esophageal cancer. It is a brutal disease with a very high rate of mortality. He had GERD when I married him. He progressed from Tums to Rolaids to Zantac to omeprozole over 45 years. No one told him he needed an endoscopy until he couldn’t swallow.
I’m very upset with the medical system and I am a nurse.
BAKING SODA IN WATER
this will get rid of reflux completely and make you bupr like a trooper, no PPI bs and no side effects – it’s that simple
GMO foods and Microwave Ovens!!!
I began to experience bad symptoms with a sore throat ( but no cold) and a constant hacking dry cough
This was almost 23 years ago. My gastric doc diagnosed me with early stages of Barrett’s and suggested the ablation. A few days after surgery, I had to go back in because food was getting stuck in my throat. My recollection is they used done kind of balloon to open up the throat. Fast forward 23 years, no signs of recurring Barrett’s but I have been on PPIs ever since. They may have had an effect on my hip fracturing while I was awaiting my date for hip replacement surgery.
We talked about the other surgeries but they were a little too radical for me. I keep hoping there will be another less radical cure. For now, I live with the status quo
Thank you for your very interesting and thoroughly researched article. I have had reflux for 9 years. Almost immediately after my 5th c-section I got SIBO and two years later reflux. I do believe they are both the result of the 5 pelvic surgeries I had. I have been going to acupuncture every week for the last 7 years. It will never cure the reflux, but it appeases it. Without acupuncture my reflux would be out of control. I ordered some of the Kfibre. Hoping it helps!
I have acid reflux and I have tried everything that’s out there and nothing help tomorrow I will call my doctor to schedule an appointment for an endoscopy. My sister passed six months ago from cancer of the esophagus.
The last part, about the bitter taste at middle night and morning, really got my interest. I have been trying for a decade to figure out why the bitter taste. Even though I don’t have frequent heartburn issues I have gone after this issue as though it were GERD or LPR. PPI’s, Gaviscon, wedge pillow, and you name it. It’s just a nasty but not sour taste, made worse if I do a mouthwash. My gastroenterologist just says if using a PPI doesn’t improve it then it is out of his realm, without suggesting who’s realm might help me. He was not interested in testing further and was dismissive of any question about the sphincter. I have excellent dental hygiene and the dentist sees no erosion of oral tissue. The article makes me want to revisit this issue but I’m not sure how to approach.
Please accept our sincere condolences on the passing of your father. Thank you so much for shedding light on this devastating cancer. I, too, lost my father to esophageal cancer. It will be 21 years since he passed on Father’s Day in 1998. My family and I started The Salgi Esophageal Cancer Research Foundation in his memory and our mission is to raise awareness, encourage early detection and to fund research of esophageal cancer. We are successfully achieving all three components of our mission and honored to share that in November, 2018, we awarded research funding for the second time since the charity was founded in 2011. Our hearts go out to everyone who has been impacted by esophageal cancer. There is a dire need for awareness of risk factors, symptoms and research for early detection, improved treatment options and underlying causes of esophageal cancer. Thank you again for sharing your father’s story.
I was diagnosed with GERD at around 23 (after years of being told my inability to swallow was because of anxiety, of course, as a woman). The doctors weren’t quite sure whether or not to put me on a PPI then, and I tried a few that didn’t seem to make much difference. Fast forward a few years, and at 28 I’ve now had four dilations due to narrowing of the esophagus and now take a PPI daily. My most recent doctor said I had the worst case he had ever seen for someone my age, so prospects aren’t great. The trouble with GERD, as this article kind of suggests, is that really aren’t any clear steps to follow. Should I be taking a PPI daily forever or not? My mother and brother both have GERD as well and take PPIs, and have had dilations, but now my mom wants to get off of them because of the side effects. After the dilations the chest pain/food getting stuck stopped for me, which is a mercy. I’ve had a lot of teeth issues, wearing away of the enamel, etc. and every morning I often cough up gunk that seems like solidified acid. Sigh.
From another science journalist, thanks very much for writing this story for everyone who suffers from this.
Excellent article. My husband suffered from acid-reflux from the time he was 16. He developed Barrett’s Esophagus in his 40’s despite taking PPI’s. Fast forward to 2015 when I came across an article in our local business journal about a physician who helped develop the magnetic ring that goes around the esophagus to help the sphincter muscle close (and lived in our community). My husband went through rigorous tests to see if the magnetic ring would work for him. As it turned out his esophageal sphincter was too week to benefit from the magnetic ring.
But, he was a candidate for the Nissen Fundoplication surgery which he did have. The operation was very successful, and he has not had to take any PPI’s or antacids since.
My late husband died at age 57 from esophageal adenocarcinoma, after many years of GERD and taking all sorts of PPIs. Was never diagnosed with Barrett’s; main symptom was trouble swallowing and after that, we were off to the races: surgery, radiation, chemo. 18 months from diagnosis to death. His surgeon–chief thoracic surgeon at Georgetown U–said she believed there must be environmental contributors and that she was embarking on that avenue of research. I never followed up with her. Too painful, even for me, as a journalist, to revisit that whole thing. Thanks for your work.
Who was his surgeon?
I’m 56 years old…and of Jewish extraction. I mention this, as, in looking at photos of your father in his youth, his facial features are so similar to mine and my father’s at that age that we could almost be related. As well, my own DNA test indicates 23% of Eastern European Jewish extract. So, I must wonder if excess stomach acid has a heavy genetic component as part of its cause.
Over the last few years, I had increasing issues with occasional acid reflux…no actual diagnosis…but occasional bouts necessitating antacids and the occassional Zantac–and, yes, some attacks were very painful. I also became incredibly intolerant of red wine. It felt like it was setting my gut on fire and eventually associated with a sore throat that constantly felt like I had just burned it with hot scalding coffee–it was unrelenting. Unfortunately for me, a red wine lover, who even made his own, stopping red wine was the only thing that truly alleviated this. I can still drink 1-2 beers/day and tolerate white wine. I believe, without any actual medical diagnosis, that maybe I actually suffer from histamine intolerance, something that I believe Zantac can also address. With abstaining from red wine, my acid reflux is all but gone now; even though what I may be experiencing is not true GERD, this article, for me, is cautionary. Thanks again for publishing.
“When I’m having a bout of reflux, I drink apple cider vinegar and sleep on a foam wedge pillow to keep it at bay. I’m not sure why the vinegar works for me — the science is lacking ”
The apple cider vinegar seems to induce the valve to close, and that keeps the acid in the stomach.
I am a 36yr old male recently diagnosed with Barret’s. I was told that I needed to go on PPIs for life. When I looked into the what PPIs long-term effects were, and the fact that I young, I did not want to go on PPIs, so I looked into other ways to treat my condition.
I found a website: http://fixyourgut.com where I worked with John to eliminate my reflux, which I did. I am now reflux free without the aid of PPIs or any other drug. I encourage folks to seek alternative methods to elimination of reflux through the use of supplementation and changing of your diet. I do not know if my Barret’s has gone away, but I will check later this year. Good luck everyone!
Adam, can you say what you did to reduce, even eliminate, your reflux?
How do you know you are now free of reflux? Though it was not covered in the article, many people have silent reflux, including silent reflux severe to cause Barrett’s and cancer. It is interesting that you would trust some dude from a website over your doctor, especially, as stated in the article, that the supposed side effects from PPIs are far from established as fact. I am confused that the fact that you are so young is an argument against PPIs. Having Barrett’s when you are so young is what should scare you.
Hi and thank you for sharing this story. I’m sorry about you losing your Dad to Esophageal Cancer. Many don’t realize that it can arise from chronic untreated/undiagnosed GERD/Reflux. As April
marks Esophageal Cancer Awareness month (the ribbon color is periwinkle), so sharing your story helps towards raising awareness. There are procedures available to help resolve GERD/Reflux by fixing the anatomical issue rather than masking symptoms with PPIs and medications. For example: Traditional fundoplication surgery ie: Nissen/Lap Nissen, which involves cutting the anatomy in the abdominal area to fix the spinster area/valve issue; and/or a Transoral Incisionless Fundoplication (TIF) surgery that is done without incisions, through the patient’s mouth and from within the stomach under full visualization of an endoscope. GERDHelp.com is a consumer education website with a lot of information for those suffering from GERD/Reflux. The bottom line is that if you’re suffering from chronic GERD/Reflux, schedule a visit to talk to your Primary Care or GI Doctor about it. They can determine next steps re: potential treatment options. Please don’t ignore symptoms or assume they are harmless. Take the next step and get a proper evaluation. It’s better to be safe now than possibly sorry later for having put it off. Today there are several effective and SAFE treatment options to help resolve GERD at the root cause of the disorder. Ask your Doctor for help.
“safe” is a relative term. I have a phamacist friend who says he would never have an abdominal surgery, because he has seen too many bad outcomes. My own experience supports his fears.
I had a Nissen fundoplication, but it somehow came undone.
So a year later, they opened me up to redo the surgery, but 3 days later my stomach ruptured.
I was in intensive care for over a month, on a respirator the whole time, and in the hospital for 67 days. And that was over the holidays, no less! Beforre Thanksgiving till late January.
Then 3 years later I got the cancer anyhow, so they removed my esophagus and most of my stomach.
But that was 18 years ago, and I am still cancer free.
I was diagnosed with GERD at the age of 16, after having terrible sore throats and a cough for nearly 2 years. That was 33 years ago and this article worries me. Thanks for shedding some light on the issue.
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