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Heartburn Heartburn Basics

Barrett's Esophagus: How Reflux Can Turn Into Cancer

For the estimated seven million people in the United States suffering from gastroesophageal reflux disease (GERD), the uncomfortable burning sensation caused by the disease is normally their primary concern. However, another condition, called Barrett's esophagus, may be lurking. While causing no immediate symptoms, Barrett's puts you at an increased risk of esophageal cancer.

How serious is this risk? Dr. Phil Katz, chairman of the division of gastroenterology at Albert Einstein Medical Center in Philadelphia, helps make sense of this condition.

What is Barrett's esophagus?
It is a change in the lining of the esophagus—the swallowing tube—from what normally is tissue that looks a little bit like skin. It's transformed to a salmon-colored, glandular type of tissue that looks like the stomach or intestine.

What causes these changes?
We're not 100 percent sure of all of the reasons why someone may get Barrett's. However, it is a problem that is associated with having acid reflux disease for a long time.

What is the risk of cancer from Barrett's?
One of the difficulties is that even though the incidence of esophageal cancer is higher in those with Barrett's than in the population without Barrett's, the number of cancers is still remarkably low. The main point is, this is a problem that does have risk, but it's not clear whether we can easily impact that risk with treatment.

Who is at risk for Barrett's esophagus?
In general, Barrett's is a disease that develops over time. If someone has had reflux for only several months to a year or two, we don't worry about Barrett's. But many people who have had minor symptoms of reflux are not asked about it. As a result, the length of the reflux is often underestimated.

How common is the condition?
In the group of people with heartburn more than two or three times a week, the prevalence is somewhere between 5 and 15 percent. If we look at the general population as a whole, it is estimated somewhere around 1 in 100.

How do you determine how long someone has had reflux?
If a gentleman in his early 50s said that he really had just started experiencing reflux over the last six months, I would be concerned that he had some heartburn occasionally for a long time and never paid attention to it. In this case, I would be a little more assertive in my questioning, because Barrett's is more commonly seen in people over the age of 50. I would ask him more questions about the reflux than if a female in her early 20s started having reflux.

Is Barrett's more common in men than women?
Barrett's is a disease—or a condition, if you would—that is more common in men, more common in Caucasians, and it is more common in people who have had reflux for more than five to ten years or in those who started refluxing before the age of 35.

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