Freaked out- Lower level cancer of the Esoph

[Knowimcrazy]

Hi Dr.,

I am 35 and have had Gerd symptoms according to my Gastro Dr. for 2-3 years off and on.  I am 6'4'' and 265, which means I am 20 pounds in the obese range and will be changing this soon.  I have not been eating well during this 2-3 year period and will be changing this also.

My Gastro has said I should get an Endoscopy to check things out, more specifically to see if I have Barrett's, because the symptoms have been going on for more than 6 months.

1. Should I worry about Barrett's?  Is it a terrible thing to have?
2. I have never drank or smoked, could I have lower level cancer of the Esoph at this age? (35).  Do many people get it at my age?  I have no symptoms other than Gerd.
3. If Gerd are my only symptoms, will getting the scopy make a real difference?  I have researched studies that say even if you are diagnosed with Barrett's that regular Endoscopies doesn't reduce Mortality rates.

What are your thoughts?

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[shnswms123]

I think esophageal cancer is very rare for anyone under 50. Barrets has a very small chance of turning into cancer. If it does, it is after many years of damage with no treatment. I would consider a scope if you have found no relief from proton pump inhibitors or other meds. Upper endoscopies monitor barret patients for cell changes. Surgeries like nissen fundoplication can help reduce acid, but usually only done in extreme cases. I think esophageal cancer usually presents with trouble swallowing, unable to eat foods, vomiting, weight loss, and other symptoms. Lifestyle changes like diet and exercise can help with your acid problem. Being overweight, particularly in the abdominal area, can cause pressure on the stomach and cause acid reflux. Good luck!

[Kevin Pho, MD]

To answer your questions:
1) Chronic GERD patients should be evaluated for Barrett's.  This is a risk factor for esophageal cancer.  Depending on the severity of the disease, it can be managed with frequent monitoring.

2) Unlikely, but possible.  Esophageal cancer presents at an older age.  An upper endoscopy would put this question to rest.

3) That is true - however it would be impossible to design a mortality study based on endoscopy frequency for Barrett's (i.e. it would be unethical to withhold endoscopy to a group with Barrett's).  Standard of care is to periodically monitor Barrett's patients - the frequency based on the severity of disease.  

Chronic GERD warrants at least one endoscopy to evaluate for Barrett's.

This option can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_