You could look at it as the body's way of trying to protect itself. The small intestine and the stomach is normally is exposed to acid every day, and so it tends to be a more resistant type of lining. So you would think, "Well, that's great, the esophagus is just becoming more resistant." The trouble is, this more resistant lining also increases your risk for developing a cancer of the esophagus and that's what we really worry about.
How many people with heartburn develop cancer of the esophagus?
The odds are definitely in your favor not to develop any of those complications.
Barrett's esophagus is found in 5 to 10% of people who have frequent heartburn symptoms—meaning at least once a week—and only 5 to 10% of people with Barrett's esophagus will develop a cancer of the esophagus. So it's a fairly small percentage of people with heartburn who are ever going to get a serious complication of the magnitude.
We don't know what causes some people with Barrett's esophagus to go on to develop cancer while others to just remain with benign disease, so the recommendation is that we recommend everybody with this condition have regular endoscopies at intervals of every three to five years, to look and see whether they're developing changes that are suggestive of cancer.
What advice would you give the 60 million Americans who suffer from heartburn?
I think most people who have heartburn will do very well with over-the-counter medications. If all their symptoms disappear with those medications, I think that they're probably just fine. If the heartburn persists, if it does not respond to over-the-counter medications, and if they have any warning symptoms, they should be evaluated by a physician.
