Hard to Digest

How to know when heartburn is more than a nuisance.

You've just eaten a big meal and settled back in your favorite chair. Then it happens. Your chest feels like it's on fire.

Heartburn. An occasional episode is nothing to worry about. But frequent or constant heartburn is the most common symptom of gastroesophageal reflux disease (GERD), a condition where digestive acids flow back (reflux) into the esophagus.

While heartburn seems like just a nuisance, a small percentage of people with GERD will develop esophageal cancer. "Esophageal cancer is increasing exponentially in developed countries for unknown reasons," says Yvonne Romero, M.D., a Mayo Clinic gastroenterologist.

Romero and her colleagues are making strides to better understand who is at highest risk of esophageal cancer -- and some answers, they believe, are in the genes. They've found evidence of genetic links by studying patients with Barrett's esophagus, a condition where cells from the esophagus change due to repeated exposure to stomach acid.

"Barrett's esophagus is to esophageal cancer what colon polyps are to colon cancer," Dr. Romero says. "It's a flag that you're at high risk." In fact, people with Barrett's esophagus are up to 125 times more likely to develop esophageal adenocarcinoma, the type of esophagus cancer that is caused by reflux, than people without Barrett's.

Caucasians have the highest risk of Barrett's esophagus and esophageal cancer. In that group, 3.5 percent to 7 percent of those with GERD symptoms will develop Barrett's esophagus.

Mayo researchers found that individuals who have a parent or sibling with Barrett's esophagus were twice as likely to have Barrett's themselves when compared to people with no close family members with the condition.

Mayo researchers are homing in on the exact genetic associations that increase risk of Barrett's and esophageal cancer. "Eventually, we'd like to develop a blood test to identify who has this precancerous lining early in the disease course," says Dr. Romero. "Then we can work to prevent it from escalating into esophageal cancer."

Doctors also know that what you eat and lifestyle choices can contribute to GERD. Food triggers can include coffee, tea, soda, chocolate, peppermint, fatty foods and alcohol. Tobacco use and obesity contribute, too. Healthy lifestyles and avoiding food triggers can help minimize symptoms, but they aren't a cure.

Currently, it takes a procedure called endoscopy, in which a slender tube with a camera is inserted down the throat, to diagnosis Barrett's esophagus. Because GERD is so common, and esophagus cancer is so rare, endoscopy isn't a practical screening tool for Barrett's esophagus, Dr. Romero says.

But if you have a close relative with Barrett's, having an endoscopic screening could be a lifesaver, she says. Like many cancers, when esophageal cancer is diagnosed early, the prognosis improves.