When Heartburn Is More Than Heartburn

By Atilla Ertan, MD, FACP, MACG, AGAFMedical Director of the Ertan Digestive Disease Center, the GastroenterologyCenter of Excellence at Memorial Hermann–Texas Medical CenterProfessor at UTHealth Medical School

It is the fastest growing cancer in the US today, increasing at a staggering rate of 600% in the last 35 years. It is also one of the deadliest cancers; this year alone, the American Cancer Society estimates about 18,000 new cases will be diagnosed and 85% of those will not survive. It has claimed the lives of people such as beloved baseball great Harmon Killebrew, Hollywood legend Humphrey Bogart and even the biological father of the Kardashian sisters, Robert Kardashian, Sr. It is the cancer that is quietly killing America: Esophageal cancer.

April has been designated Esophageal Cancer Awareness Month. It is time to get the word out about this highly preventable disease. Knowledge is power and earlier detection means more lives saved; if caught in an early stage, esophageal cancer is easily treatable and highly curable.

The crucial link is heartburn. In the US, esophageal cancer is most often caused by heartburn and, according to the American College of Gastroenterology, as many as 10 million Americans reportedly experience heartburn every single day. No doubt you yourself are familiar with the feeling: That burning pain in the throat and/or chest just behind the breastbone that occurs shortly after eating and lasts anywhere from a few minutes to several hours. The most common causes of heartburn or acid reflux include: Smoking, alcohol, carbonated drinks, coffee, chocolate, spicy foods, fatty or fried foods, anything tomato-based like pizza or spaghetti ... basically, the typical American lifestyle and diet!

Heartburn can also be triggered by eating an especially heavy meal and then lying down or by being overweight in general. In fact, the recent rise in esophageal adenocarcinoma – cancer of the glandular cells in the esophagus caused by chronic acid reflux – directly parallels the rise of obesity in our nation. It has increased 350% in the last 10 to 15 years and is now the most common form of esophageal cancer, occurring in 9 out of 10 patients, according to the Esophageal Cancer Action Network. Mirroring this, data from the Centers for Disease Control and Prevention indicates that, in 1990, the US obesity average was only 12%. Fast-forward 20 years to 2010 and that number jumped to 36%, marking a 200% increase.

But, you may be asking, how does chronic heartburn turn into cancer? Persistent heartburn or gastroesophageal reflux disease (GERD) is loosely defined by suffering from heartburn at least two or more times per week. This constant presence of stomach acid in the esophagus can cause the cells in the esophagus to literally change, leading to a condition known as Barrett’s esophagus. Once this condition is diagnosed, patients have a 30- to 125-fold increased risk of developing esophageal cancer. The American Gastroenterological Association estimates there are more than 3.3 million Americans currently living with Barrett's esophagus.

It is important to note that there are some contributing factors to developing esophageal cancer that cannot be controlled. For instance, the lifetime risk for men is about 1 in 125 while, in women, it is only about 1 in 435. Age also plays a decisive role – about 8 out of 10 people diagnosed are between the ages of 55 and 85. But unlike some other cancers, esophageal cancer may also be highly preventable with just a few simple, yet significant lifestyle changes:

Get in shape. Obesity leads to acid reflux which, as demonstrated, is substantially responsible for the rapidly increasing rates of esophageal cancer. Make it a personal goal to lose weight by exercising regularly, three to four times a week. If necessary, consult with your doctor first.

Eat well. Make the super fatty and fried, drive-thru foods the exception not the norm. Try to eat more lean proteins, whole grains and lots of fruit and vegetables. Avoid certain foods and beverages such as coffee in any form, caffeinated drinks, peppermint, chocolate, alcohol, citrus fruits and juices, and tomato products.

Should you eat or drink something that is highly acidic, take an antacid. Beat your stomach acid to the punch by neutralizing it before it backs up into the esophagus. Or take a proton pump inhibitor which will shut down many of the acid pumps in your stomach for a full 24 hours – but do not rely on either of these methods regularly or exclusively.

Do not go to bed right after dinner. Lying down immediately following a meal can allow the contents of that meal to make their way back up into the esophagus, especially for those with a faulty valve between their esophagus and stomach. Be sure to wait at least three hours after dinner before getting horizontal on the couch or hitting the hay.

Once you get in bed, keep your head up.It might be helpful, especially if you suffer from acid reflux, to elevate the head of your bed anywhere from six to eight inches. Using thick books or boards for this is probably the most economical solution. Just place them under the bedposts at the head of the bed, being careful to put an even amount of books or boards on both sides for equal balance. Do not attempt to elevate your head with pillows alone.


Stop smoking. In this day and age, there certainly is no shortage of reasons to quit smoking and chewing tobacco. This is just one more.


Dress comfortably. Avoid tight clothing or belts, which may increase abdominal pressure.


Talk to your doctor or a gastroenterology specialist. If you or your loved one is experiencing heartburn twice a week or more, and has been doing so for an extended period of time, go now and get screened for possible esophageal cancer or, its predecessor, Barrett’s esophagus.

We here at the Ertan Digestive Disease Center specialize in treating basic and complicated Barrett’s esophagus cases. We have performed more than 600 special endoscopic ablation procedures on Barrett’s patients with dysplasia (abnormal cell growth) and/or early cancer and have helped train various other gastroenterologists locally, nationally and internationally. If you have any questions or would like more information, please visit us on the web to learn more about Barrett’s esophagus or esophageal cancer.

Please help us spread the word about this dangerously deadly yet still widely unknown epidemic. And if you are one of the 10 million Americans suffering from heartburn every day, talk to your doctor or specialist today – don’t wait until it‘s too late.

About Dr. Atilla Ertan

Dr. Atilla Ertan is a Professor of Medicine in the Gastroenterology and Hepatology Division at the University of Texas Health Science Center at Houston Medical School and Medical Director of the Ertan Digestive Disease Center, the Gastroenterology Center of Excellence at Memorial Hermann- Texas Medical Center in Houston. Dr. Ertan has achieved national and international recognition as an outstanding clinical scientist, educator, researcher, and administrator in the field of gastroenterology.  He has published over 160 articles in peer-reviewed journals, book chapters, and books and has received numerous awards and honors.   Most recently, Dr. Ertan was chosen out of 250,000 Turkish Americans for his outstanding contributions to Society to receive Turkish American of the Year Award by the Assembly of Turkish American Association in Washington D.C.  In October 2003, Dr. Ertan received the Master in Gastroenterology Award from the American College of Gastroenterology (ACG) for his dedicated work with patients and his innovative research efforts. Dr. Ertan also has been named to the Top Doctors List in Houston and in the US since 1995. Learn more about him on his website atillaertan.com.

About Memorial Hermann – Texas Medical Center

Founded in 1925, Memorial Hermann was the first hospital to open in the world-renowned Texas Medical Center in Houston. For more than a century, the hospital has set new standards of care in Texas and across the nation. Built on a long-term affiliation with The University of Texas Health Science Center at Houston (UTHealth) Medical School, Memorial Hermann – TMC and Children’s Memorial Hermann Hospital bring together a world-class team of clinicians, researchers and educators under one roof.  The 865-bed Campus provides exceptional care in the areas of trauma, heart, neuroscience, orthopedics, women's health, general surgery, organ transplantation, oncology and more.  As a certified Level I trauma center at Memorial Hermann-TMC and Children’s Memorial Hermann Hospital, Memorial Hermann is home to the Texas Trauma Institute and provides 24-hour emergency and trauma care. In 1976, the hospital established Memorial Hermann Life Flight® – the first air ambulance service in Texas – which currently performs more than 3,000 annual missions with a fleet of six state-of-the-art helicopters. Memorial Hermann – TMC encompasses three renowned institutes including the Mischer Neuroscience Institute, the Heart & Vascular Institute and the Ironman Sports Medicine Institute - all offering the latest innovations, technology and treatment. Learn more about Memorial Hermann - Texas Medical Center.

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