Patient with Barrett’s esophagus concerned about cancer risk

Dear Dr. Roach: After many years of dealing with reflux, I have now developed Barrett’s esophagus. The biopsy said “Barrett’s/ intestinal metaplasia.” After speaking to the nurse at my gastroenterologist’s office, she explained that they were the “same thing.”

Needless to say, I’m a bit concerned knowing that this diagnosis is a precursor to esophageal cancer. I am really careful with my diet and have adjusted to having very little caffeine, chocolate, tomato sauce and other things that may cause acid production. Having had a motility test done recently, I was told that my reflux isn’t my main issue and that it’s actually the very slow motility of my esophagus.

What are your thoughts on this? Am I destined to end up with a cancer diagnosis? I am unable to speak to my gastroenterologist for another month. I am pretty scared. — P.O.

Dear P.O.: Food goes down the esophagus through the lower esophageal sphincter (LES) and into the stomach. The lining of the stomach is specially adapted to the strong chemicals needed for digestion, which can damage other cells. Stomach contents, including acid and bile, are not supposed to get into the esophagus.

However, in many people, stomach contents do go backward (“reflux”) through the sphincter and into the esophagus. If this happens for long periods of time, the lining of the esophagus changes in response to acid and bile, which is known as metaplasia. This protects it against chemicals, but it also predisposes people to cancer.

Reducing acid in the esophagus is thought to slow progression of Barrett’s. Caffeine weakens the LES, which is why it isn’t recommended in people with symptomatic reflux and those with Barrett’s.

A slow movement of the esophagus lets those toxic chemicals from the stomach stay in the esophagus longer, causing persistent damage. Medications to stop acid production, like omeprazole, seem to reduce cancer risk; although this is not definitive, most experts believe it to be true based on theory and observational studies. Aspirin and statins also may have benefits, but the data are not strong enough for me to recommend them as preventive agents at this time.

While I fully understand being scared of developing cancer of the esophagus, fortunately it is not common. On average, ¼ of 1% of people with Barrett’s will develop cancer each year. Your risk for developing esophageal cancer is higher than people who don’t have Barrett’s, but it’s still low overall. Your gastroenterologist will likely recommend periodic screening of your esophagus to look for any precursor lesions of cancer.

Dear Dr. Roach: In a recent column, you said there wasn’t any treatment to stop the progress of osteoarthritis. Some years ago, I began to have osteoarthritic symptoms in my big toes, then in my thumbs. I tried glucosamine and chondroitin for a couple years with no apparent benefit. Then I tried turmeric, and I saw some reduction in joint pain. So, I upped the dose to 2,000 mg twice a day and had complete relief of pain. I know this is a sample size of one, but it is working for me! — J.E.

Dear J.E.: There are treatments that can improve symptoms. Anti-inflammatory medicines like ibuprofen help many people. Turmeric has anti-inflammatory properties, too, and I have many patients who benefit from it. Unfortunately, none of these repair or stop damage to the joint.