Heartburn sufferers, take warning. The medications that you take to treat your heartburn, called proton pump inhibitors, or more commonly known as drugs such as Prilosec, Nexium or Prevacid, may have a serious side effect.
A recent study in the Archives of Surgery suggests that long-term use of these medications may lead to adenocarcinogenesis, a lethal form of esophageal cancer. The study theorized that screening for esophageal cancer has previously focused on identifying Barrett’s esophagus, a pre-cancerous condition that occurs when the lining of the esophagus begins to go through a change and the cells begin to look more like small intestine cells, in patients with severe, long-standing symptoms of gastroesophageal reflux disease (GERD). However, 95 percent of patients who develop esophageal cancer are unaware of that they had Barrett’s esophagus before their cancer diagnosis, as their GERD symptoms were not severe, which means they never had been screened.
One possible explanation is that no correlation exists between the severity of GERD symptoms and cancer risk. The study suggest that severe GERD symptoms are not associated with an increase in the prevalence of Barrett's esophagus, dysplasia or cancer in patients undergoing primary endoscopic screening.
The study also proposes that these proton pump inhibitors may actually increase cancer risk, especially in those patients who experience less severe symptoms of gastroesophageal reflux disease. According to the study, medically treated patients with mild or absent GERD symptoms have significantly higher odds of esophageal cancer than those patients with severe GERD symptoms.
Researchers studied more than 760 patients with GERD from 2004 to 2007 and discovered that an increasing number of severe GERD symptoms correlated positively with endoscopic findings of esophagitis, or swelling of the esophagus. Conversely, an increasing number of severe GERD symptoms were associated with decreased odds of esophageal cancer.
“The theory is that patients who have more severe symptoms of GERD, get an esophagogastroduodenoscopy, or EGD, and are thus screened better, whereas patients without symptoms do not get an EGD and can develop esophageal cancer over time,” said Paul Lebovitz, MD, division director of gastroenterology at Allegheny General Hospital.
An EGD is an examination of the lining of the esophagus, stomach, and upper duodenum with a small camera, called a flexible endoscope, which is inserted down the throat.
“I do not believe proton pump inhibitors increase the risk of cancer, but one of the theories is that patients reflux more bile if their stomach is void of acid, and this might be a possible cause of cancer,” Dr. Lebovitz said. “We do not really have significant data to support this conclusion, in my opinion. However, as we know with these types of studies, there need to be more questions asked, more data published and close follow-up with patients on these medications, as with any medicine.”
Does this study suggest that all patients who take proton pump inhibitor medications now undergo endoscopy screening for cancer? Not necessarily, according to Dr. Lebovitz.
“I think that would be too far of an extension from the study. The role of endoscopy screening has always been about risk factors and alarming symptoms, such as white men in their 50s, complaints of weight loss and difficulty swallowing.
“In our practice, we have been worried about these medications simply masking the symptoms, so we also do an endoscopy in patients with GERD that has been treated for 10 years. There have been suggestions of such practices in professional society guidelines, and this study suggests this, as well, as a possible option for patient care in patients with GERD.”
According to Dr. Lebovitz, patients with Barrett’s esophagus are treated for those specific symptoms and undergo repeat EGDs with biopsies that will detect cancer at its earliest stage. There is also treatment with ablation therapies, but most patients with Barrett’s esophagus just undergo routine screening.
For more information or to schedule an appointment with Dr. Lebovitz, call 412-359-8900.