Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Let’s talk about stomach acid! It can cause serious issues if consistent heartburn is left untreated.
Repeated exposure to stomach acid can change the cells lining the esophagus and potentially increase the risk of esophageal cancer.
“We’ve all experienced that uncomfortable feeling in your chest after eating a big meal, especially if it’s spicy or when you had one too many cups of coffee or caffeine,” Sommer said. “But frequent heartburn isn’t always harmless.”
Sommer explained that when acid reflux happens repeatedly over many years, it can cause changes in the lining of the esophagus, leading to a condition called Barrett’s esophagus.
“I don’t want anybody to panic,” she said. “I don’t want anybody out there to think, ‘Oh my God, I have heartburn all the time. I have cancer.’ That’s not it.”
Instead, Sommer said the goal is to educate people about what can happen when recurrent heartburn is not properly addressed.
The esophagus is the muscular tube that carries food from the mouth to the stomach. A muscular valve between the esophagus and stomach is supposed to prevent stomach contents from flowing backward. When that valve does not work properly, acid and other digestive contents can move into the esophagus, causing acid reflux.
When reflux becomes frequent, it is known as gastroesophageal reflux disease, or GERD.
Repeated exposure to stomach acid can eventually cause the normal cells lining the esophagus to change and begin resembling cells typically found in the intestines. That process is known as intestinal metaplasia and is associated with Barrett’s esophagus.
Although Barrett’s esophagus is not cancer, it is considered a precancerous condition because it can increase the risk of developing esophageal cancer.
“Most people that get diagnosed with Barrett’s esophagus will never develop esophageal cancer,” Sommer said. “But the point I’m trying to make is, once those changes have been identified, we just need to monitor you and intervene when appropriate.”
Chronic acid reflux is the primary risk factor, but other factors can increase the likelihood of developing Barrett’s esophagus. Sommer identified being over age 50, being male, carrying excess weight around the abdomen, smoking and having a close family member with Barrett’s esophagus or esophageal adenocarcinoma as additional risk factors.
People do not necessarily have to experience severe heartburn to have the condition, she added.
“Sometimes reflux can be silent,” Sommer said. “People don’t know they have reflux at all, but they have other things like a chronic cough, or they think they have a sinus infection.”
When symptoms such as a persistent cough, hoarseness or throat irritation are not relieved by treatments for other suspected causes, acid reflux may be worth investigating.
Other symptoms can include a burning sensation in the chest, particularly after eating or when lying down, a sour taste in the mouth, food or acid coming back up into the throat and frequent belching.
Sommer warned that people should not ignore more serious symptoms, including unexplained weight loss, persistent vomiting and gastrointestinal bleeding.
“If you have blood anywhere, if you vomit blood, or if you have blood in your stool, you need to get that checked out right away,” she said.
Diagnosing Barrett’s esophagus typically involves an upper endoscopy, also known as an EGD. During the procedure, a physician passes a camera through the esophagus and into the stomach to examine the tissue. Biopsies may be collected and sent to a pathologist for examination under a microscope.
Sommer said patients sometimes become alarmed when they learn that tissue samples have been taken, but a biopsy does not automatically mean a physician suspects cancer.
“It’s just to determine whether there are any type of abnormalities occurring or beginning to occur,” she said.
The biopsy results help determine whether a patient has Barrett’s esophagus without dysplasia or with dysplasia. Dysplasia refers to abnormal changes in cells that may indicate a greater potential for progression toward cancer. High-grade dysplasia involves more significant abnormalities and requires particular attention.
“The pathology is important to determine what happens next,” Sommer said. “It’s going to put you on a plan of how to manage it, treat it, and, you know, keep screening for it.”
Sommer emphasized that early identification and monitoring are important because esophageal cancer can be difficult to treat once it advances.
Treatment typically begins with controlling acid reflux. Proton pump inhibitors, including omeprazole and pantoprazole, reduce the amount of acid produced by the stomach. Some patients may also need procedures to treat abnormal tissue if precancerous changes are found.
Sommer stressed that medication can help control reflux but does not eliminate Barrett’s esophagus itself.
“They do not make Barrett’s go away,” she said of acid-reducing medications. “It’s just treating the symptoms of the acid to help prevent the cells in the esophagus from changing.”
Lifestyle changes can also help people manage reflux. Sommer recommended avoiding food for two to three hours before lying down and paying attention to foods and beverages that trigger symptoms. Potential triggers include spicy foods, tomato sauce, citrus fruits, chocolate, peppermint, coffee and alcohol.
For patients already diagnosed with Barrett’s esophagus, follow-up endoscopies are important. Sommer said the recommended frequency depends on the biopsy results and the length of the affected area. Patients without dysplasia are often monitored every three to five years, while those with abnormal cellular changes may require closer follow-up or additional treatment.
Sommer’s advice for people experiencing frequent heartburn was straightforward: Do not rely indefinitely on over-the-counter medications without discussing persistent symptoms with a health care provider.
“Occasional heartburn is common. We can all get it,” she said. “But if you have chronic acid reflux or it occurs, you know, daily or several times a week, and you’re reaching for those antacid medications, you need to discuss that with your provider.”
She emphasized that a diagnosis of Barrett’s esophagus is not the same as a cancer diagnosis, but it does require appropriate attention.
“Early detection and appropriate follow-up can make a tremendous difference,” Sommer said, encouraging patients to take prescribed medications and follow their providers’ recommendations for routine screenings.
Key West Surgical Group is located at 3134 Northside Drive in Key West. More information is available at KeyWestSurgicalGroup.com or by calling 305-294-1041.