Gastroesophageal reflux disease (GERD) is a very common disease, affecting about 20% of the UK population. Although GERD was known to be irritating to a person’s life, it was seen as quite safe for the vast majority of cases, and not detrimental to life expectancy or lifestyle. However, as the latest research shows that GERD increases the incidence of certain types of cancer significantly, it is important to look at GERD’s relationship with cancer.
Firstly, what is GERD? As stated previously, GERD stands for Gastroesophageal reflux disease and is a highly prevalent disease in the world and the UK. GERD occurs when stomach acid habitually flows from the stomach into the oesophagus. This back-flow of stomach acid is called acid reflux. Acid reflux into the oesophagus can be an irritant to the oesophagus’ epithelium. Although acid reflux occurs for many people, it is not classified as GERD, unless this acid reflux occurs at least once or twice a week, depending on the severity of acid reflux.
The reasoning behind GERD is that the lower oesophageal sphincter, which lies between the oesophagus and stomach, closes to prevent the back-flow of stomach acid into the oesophagus. However, in the case of GERD, this sphincter is weakened or has an abnormal relaxed shape. This results in gaps in the sphincter allowing stomach acid to enter the oesophagus.1
The common symptoms of GERD include heartburn after eating, chest pain, difficulty swallowing and vomiting. GERD symptoms are usually exacerbated at night-time, due to the horizontal positioning of the body when sleeping.
The long-term effects of chronic GERD consist of, the formation of an oesophageal ulcer, the oesophagus narrowing, as well as the new-found relationship between GERD and cancer, which will be covered now.
To clarify, it has been known before now that GERD can increase the incidence of cancer, however, this new research shows that the relationship between GERD and cancer occurrence, is much more significant than first thought. In this research, GERD is shown not to greatly change the incidence of non-oesophageal cancers but does massively increase the incidence of oesophageal cancer. Before the statistics are analysed, you should understand how GERD can be related to higher oesophageal cancer chances. Acid reflux in GERD, can damage oesophageal tissue, increasing the chances of laryngeal squamous cell carcinoma (LSCC), oesophageal squamous cell carcinoma (ESCC) as well as oesophageal adenocarcinoma (EADC). GERD is more likely to increase the risk of developing adenocarcinoma cancer rather than squamous cell cancer.
The research in question was carried out in the USA, by the American Association of Retired Persons (AARP). The participants were between 50 and 71 years of age, from all across the USA. A limitation of this research is that 92.6% of participants were non-Hispanic white, even though only 62.8% of the USA’s population are such. However, in the context of the UK, this is not too different from the UK’s non-Hispanic white population at 86.2%, so the data is useful when taking from the UK perspective. The research shows 16.92% of LSCC cases and 17.32% of ESCC cases within the participants had GERD, showing the significance of GERD, considering that by the age of 50+ many GERD patients have surgical intervention, stopping their GERD. Furthermore, there is a greater link between patients who have both GERD and Barrett’s oesophagus and the chance of having oesophageal cancer increases. About 17% of people with GERD develop Barrett’s oesophagus, which is when the stomach acid changes the composition of the lower oesophageal epithelial tissue.2
How can someone prevent the contraction of GERD? Risk factors for GERD include obesity (the main risk factor) as well as smoking, taking aspirin, drinking coffee and/or alcohol, eating fried or high-fat foods, eating late at night and finally eating large meals.
How can someone with GERD prevent having Barrett’s oesophagus? The same risk factors apply as for GERD, but having an elevated pillow for your head (also known as a wedge pillow) when sleeping is even more paramount for people in this situation.
How can someone with GERD prevent oesophageal cancer, with/without Barrett’s oesophagus? Again the same risk factors apply as before, but exercise is extremely important at this stage compared to before. Also, regular screening is necessary at this point to be able to act on oesophageal cancer at an early stage, if it occurs, increasing your life expectancy.
Therefore, although GERD and its related diseases increase the incidence of oesophageal cancer significantly, there are ways to prevent the situation from becoming worse at each stage. Furthermore, surgery can be done, albeit slightly dangerous, in the form of a fundoplication or other methods, fixing the sphincter in question. In conclusion, oesophageal cancer can be prevented or treated in many ways for GERD patients, but widespread information by the NHS is required for the incidence and death rate of oesophageal cancer from GERD to decrease.