Esophageal Cancer Caused by GERD

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I'm Deborah Howell. Today our guest is Dr. Atif Iqbal, Medical Director of the Digestive Care Center at Orange Coast Medical Center. More than 17,000 people will be diagnosed with esophageal cancer this year. Untreated gastroesophageal reflux disease, or GERD, can cause precancerous changes called Barrett's esophagus. It's important to know the signs, symptoms, and prevention measures for esophageal cancer, and how GERD can lead to this type of cancer if not addressed and treated properly. Welcome, Dr. Iqbal.

Atif Iqbal, MD: Oh, thank you so much for having me.

Deborah Howell (Host): Our pleasure. Can we start with the definition of GERD, please?

Atif Iqbal, MD: Yeah, GERD or gastroesophageal reflux disease is a progressive disease that occurs as a result of chronic exposure of acid in the esophagus, and that is mainly due to the weakness or incompetency of a ring-shaped muscle which is at the junction of the esophagus and the stomach. Normally, it prevents the backflow of the acid, but when it is not working well, then the acid continues to cause damage and moves upward, which is normally not the case.

Deborah Howell (Host): I see. Now, if severe GERD goes untreated for a long period of time, how can it affect your overall health?

Atif Iqbal, MD: Yeah, unfortunately, if GERD is continuous and stays for a long time, and specifically for over five years, it ultimately causes progressive damaging of the inner lining of the esophagus. And that leads to changes and which subsequently over the period of time leads to a condition called Barrett's disease. And Barrett's disease is just the change in the inner lining of the esophagus, which ultimately changes into pre-cancer unfortunately, and a cancer eventually.

Deborah Howell (Host): I see. So what is esophageal cancer then, and how common is it for someone to develop this type of cancer if they have severe untreated GERD?

Atif Iqbal, MD: Yeah, so esophageal cancer is a very unique cancer. It is, unluckily, I would say, it's not breast or colon cancer, which are considered more 100% curable and more friendlier. It is a very aggressive cancer. In the United States, there are two different types of esophageal cancer. One is the squamous cell, and the cause of that cancer is smoking and alcohol. Which is 10% of the US population can unfortunately get that. 90% of the esophageal cancer is adenocarcinoma, which is a specific cancer that occurs because of chronic gastroesophageal reflux disease or Barrett's disease. So it is common. The incidence has increased up to 700% in the last 10 years, and it is very unfortunate because of the misdiagnosis or underdiagnosis that is progressively increasing.

Deborah Howell (Host): That's an astounding statistic.

Atif Iqbal, MD: Yeah.

Deborah Howell (Host): Wow. What are some of the common symptoms then to look out for to avoid developing esophageal cancer?

Atif Iqbal, MD: So the cause of the cancer as I mentioned is acid reflux. And we have, if any patient who is suffering for any kind of acid reflux, meaning heart burns, regurgitation, acid taste in their mouth, a lot of bloating, and they take more than one or two pillows every night before sleeping, that's the sign that they already have a disease. But we really have to diagnose it before we treat it. And that's the key of everything, because that will lead to eventually Barrett's and then cancer. Now, when the cancer eventually develops, unfortunately, it does come up with the complaints of weight loss. A patient notices that he or she has a weight loss. Complete loss of appetite, and sometimes bloody vomiting that comes in the later stage, but that is a little bit advanced stage and obviously we want to diagnose and treat much earlier than that.

Deborah Howell (Host): Yes, so important to catch it early. Now, are GERD and esophageal cancer more common with women or men?

Atif Iqbal, MD: Yes, so studies have shown that men have three times more higher incidence of developing cancer, esophageal cancer, and also it has shown ethnicity-wise Caucasian population has much higher incidence of esophageal cancer versus African Americans.

Deborah Howell (Host): Okay, so important for everybody to catch it, but certainly for white males to really keep an eye on this.

Atif Iqbal, MD: Yes. Absolutely.

Deborah Howell (Host): Are there measures that someone can take to avoid developing GERD to begin with?

Atif Iqbal, MD: I think we can start from basic lifestyle changes, eating healthy and not eating fried food, and maintaining your weight, avoiding too much caffeine or chocolate, occasionally literature will say spices and stuff. So the weight gain and diet modifications, and increased strenuous exercise which increases intra-abdominal pressure can cause hiatal hernias as well, and the herniation of the stomach into the chest can also lead to GERD. So I think these things daily basis changes and living a healthy life can absolutely prevent the GERD.

Deborah Howell (Host): Now when you say I have to go back to an excess of chocolate because of course you know, all women... Most men love it. So when you say, you know, don't have too much chocolate, you can have a little, right?

Atif Iqbal, MD: Absolutely, absolutely. I think everything or anything in moderation is perfectly fine.

Deborah Howell (Host): Okay. Fantastic. Okay, so don't take my chocolate away. All right. What are the steps that someone should take if they feel like they may be suffering from extreme GERD, or maybe developing a more progressed stage of GERD?

Atif Iqbal, MD: Yeah, I think it's a great question. And in life we live we get busy and you know, can't find time, but I think these things should not be ignored. First thing they have to do is go to their primary care physician and have a very open discussion about it. And ask them that, hey, I've been taking this over-the-counter medication or somebody prescribed me, but I really want to have this diagnosed properly. So I think that would be the first step to do, and then I'm sure the primary care physician will refer them to gastroenterologist for upper endoscopy, which is a very short procedure, takes about five minutes, and they will be able to put a camera through the mouth and visualize directly the esophagus and stomach to see if there are any early changes that are concerning and what we have to do about that.

Deborah Howell (Host): And when you go to your GP for your annual visit, do they do anything to try to determine if there are GERD symptoms?

Atif Iqbal, MD: So the standard examination, primary care physician does not include an analysis or screening of any kind for the GERD. I think the primary care physician in our community mostly rely on patient's history and if there are any complaints relevant to that, they may go ahead and send them to the gastroenterologist, but that's not as common as it should be.

Deborah Howell (Host): Now, you have said primary care physician a couple of times, which leads me to believe I was saying something old school when I said GP as in general practitioner. Can you tell me the difference or what I should...

Atif Iqbal, MD: It is pretty much the same thing. And everybody call it different, some people call it family practice, some people call as primary care or general practitioner. Basically, they're internal medicine specialists, and their responsibility is to just maintain and evaluate the common health issues and common medical problems and manage them, and then refer them to an appropriate specialist.

Deborah Howell (Host): So I won't be offending my primary care physician if I call him a GP?

Atif Iqbal, MD: No, you will not.

Deborah Howell (Host): Do you have anything else, final thoughts on GERD?

Atif Iqbal, MD: I think once again an important thing in this topic is definitely do not to wait. Barrett's disease is a bridge between a GERD and a cancer. And when Barrett's comes, this is already a red flag that cannot be ignored. The patients with Barrett's needs to have a surveillance endoscopy, which means a checkup of their esophagus and stomach every year, to make sure the pre-cancer cells are not changing into cancer because they need a treatment for that, and the treatment has to be provided once it's diagnosed. And then obviously, the treatment is also based on what diagnosis and what stage the disease is based on that we offer the treatment for that. One more important thing is that a lot of patients with Barrett's disease have silent personalities. What does that mean, they do not have any symptom, and they do have acid reflux. Besides that, they think that's maybe general complaint. But nobody will ever actually know that the Barrett's will be there and how would it present unless you have an advanced disease, which is cancer that has weight loss and all the things we talked about.

Deborah Howell (Host): So forearmed is forewarned.

Atif Iqbal, MD: Absolutely.

Deborah Howell (Host): Stay on it, stay on it, stay on it. Thank you so much, Dr. Iqbal, for joining us today, we really appreciate having you on the show.

Atif Iqbal, MD: Thank you so much to you guys as well.

Deborah Howell (Host): So informative. To listen to the podcast or for more information, please visit memorialcare.org/podcasts. That's memorialcare.org/podcasts. And don't forget to see your primary care physician once a year. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have a fantastic day.