The pain of chronic heartburn Featured

10:27am EDT July 31, 2006
We’ve all had it happen to us before. When put in a stressful situation at work, first the stomach gets uneasy, followed by a fiery burp. It’s just nerves making the stomach upset, right? Not necessarily.

“Gastroesophageal reflux, or heartburn, is the No. 1 cause of esophageal cancer,” says John Lipham, director of the Center for Heartburn and Swallowing at Chapman Medical Center in Orange County. “There’s been about a 600 percent increase in this type of cancer in the last 20 years, all due to gastroesophageal reflux.”

Smart Business talked to Lipham about what can be done to correct the problem.

Is the workplace more stressful today, or are more people seeking treatment for the condition?
I believe it’s a combination of the two. Clearly stress makes reflux worse, and I think we have much more stress today than we did 20 or 30 years ago. Unfortunately, because of the advertisements for the different drugs on television and the radio, I think people are lulled into a false sense of security, thinking it’s just heartburn and nothing to worry about. Many people don’t realize that it can lead to much more serious complications, including cancer.

How effective are available medications?
The medications, whether prescribed by a doctor or purchased over the counter, do nothing more than mask the symptoms of reflux. They decrease the amount of acid in the stomach, which reduces the symptom of heartburn. However, there are other powerful digestive enzymes such as bile and pancreatic enzymes in the stomach, and when you have reflux they are all involved.

At the end of the esophagus is a protective, one-way valve called the lower esophageal sphincter. The only way you get reflux is when that valve isn’t working. Gastroesophageal reflux is a mechanical problem. It has nothing to do with acid in the stomach.

The condition is advertised on television as an acid reflux condition because the pharmaceutical companies have a drug they can sell you that will decrease — if not eliminate — the heartburn symptoms. People feel better, but they don’t realize that they still have the same amount of reflux, they just don’t feel it. The medications do not correct the problem with the defective valve. A lot of damage is still occurring to the inside of their esophagus. They don’t realize they have a problem until one day they can’t swallow because they either have a large tumor, cancer or scar tissue inside their esophagus.

How can the problem be treated?
If a person has had symptoms for more than a few years, the best thing to do is see a specialist about having an endoscopy, where a doctor puts a small camera inside the esophagus and stomach and can visualize what kind of damage has been done.

Unfortunately, none of the complications associated with reflux produce any symptoms until they are quite advanced. Esophageal cancer has no symptoms until it completely obstructs the esophagus and food begins to get stuck. Once it does that, it’s impossible to go back and undo it, even if you remove the stress.

Do medications work at all?
It’s important to remember that medications aren’t protecting against the damage that’s being done to the inside of the esophagus, specifically the cancer risk. A New England Journal of Medicine study in 1999 showed that people who took medication for reflux were three times more likely to develop cancer as opposed to people with equally as severe reflux who didn’t take any medicine. Not only were the medications not protecting people from cancer, but they were actually increasing the risks.

Are certain industries more stressful than others?
I think executives in the corporate world are in a very stressful area of business. It seems like more of a white-collar disease. It seems to affect men more than it does women. We see 60 percent to 70 percent of white-collar males as the primary individual that suffers from gastroesophageal reflux.

Is reflux genetic?
We don’t really have an answer to that yet. We don’t even know what predisposes someone to reflux, although we think it may be at least partially genetic since it tends to cluster in families. I’ve treated fathers and sons, mothers and daughters, so there is certainly a genetic aspect to it.

Stress makes it worse, as does the American diet. The American way of ‘inhaling’ a meal almost certainly contributes to reflux and partially explains why we have more reflux problems than any other country. Bottom line is that part of it seems to be genetic and part of it is lifestyle.

JOHN LIPHAM is medical director of the Center for Heartburn and Swallowing at Chapman Medical Center in Orange. Reach him at (714) 288-8098 or jlipham@surgery.usc.edu.