Before your doctor takes a “just in case” look down your throat for trouble, make sure you really need this procedure.
One in five men has felt the burning discomfort of heartburn in the past month, and for many men it is a chronic malady requiring daily medication. For a variety of reasons, those with chronic heartburn end up having one or more endoscopies, in which a doctor uses a flexible lighted instrument to check for trouble down below in the esophagus.
Who with chronic heartburn really needs an endoscopy—and why? For insights and an update on the latest medical guidelines, we asked Dr. Kunal Jajoo, an endoscopist and assistant professor of medicine at Harvard-affiliated Brigham and Women’s Hospital. Even in an age when unnecessary tests and procedures are all too common, endoscopy can be beneficial to men with chronic heartburn—but only if they really need it. “Heartburn in and of itself doesn’t require endoscopy,” Dr. Jajoo says. “But if you have other symptoms definitely discuss them with your doctor.”
Heartburn & esophageal cancer: What’s your risk?
According to a recent study in Denmark, the risk of esophageal cancer among people with the most common form of Barrett’s esophagus is lower than experts thought. Out of 1,000 people with Barrett’s, 12 would develop esophageal cancer over a period of 10 years. This is 30 times the cancer rate in people who do not have Barrett’s, but overall the cancer is still uncommon
Heartburn and endoscopy
If you are middle-aged and older and have chronic heartburn, it’s probably gastroesophageal reflux disease (GERD). It occurs when the acidic contents of the stomach back up (reflux) into the base of the esophagus—the tube that normally channels food and drink in the other direction. Taking an acid-reducing medication cools heartburn symptoms and allows the surface of the esophagus to heal.
In ordinary cases of GERD treated successfully with medication, “just in case” exams of the esophagus with endoscopy are not likely to produce any information that would change treatment. At the same time, you would still face a small chance of complications from the procedure and the inconvenience and expense.
If you try medication and still have heartburn symptoms after one to two months, your doctor might recommend an endoscopy to check for other things that might explain your troubles, like ulcers or acid burns (erosions) on the wall of the esophagus or stomach.
Endoscopy is also in order if you have GERD symptoms along with certain “alarm” signs, such as difficulty swallowing, significant weight loss, gastrointestinal bleeding, or anemia. “You would be concerned about a possible cancer that is delaying the emptying of stomach, which could cause reflux,” Dr. Jajoo says.
Age and medical history are also important factors, Dr. Jajoo says. It is uncommon for adults older than 50 to suddenly start having acid reflux symptoms.
If you have GERD and get an endoscopy, there’s a chance the doctor may see abnormal changes at the base of the esophagus. This condition, called Barrett’s esophagus, is more common in men than in women. The most common form of Barrett’s esophagus raises the risk for developing one type of esophageal cancer.
Until recently, the annual risk of cancer in people with Barrett’s was thought to be about one in 200. But an important study in Denmark found the risk may be much lower—about one chance in 1,000. For ordinary, low-risk Barrett’s, guidelines recommend follow-up endoscopy every three to five years to check for precancerous changes. If the Barrett’s starts to look more abnormal, you will be advised to have more frequent follow-up.
Checking for Barrett’s
Although relatively uncommon, esophageal cancer has a high death rate. Should everyone with a history of GERD get checked, at least once, for Barrett’s?
Experts don’t all agree on who should be screened and how often. Both the American Gastroenterological Association and the American College of Physicians say that screening might be considered for men with GERD and other risk factors for esophageal cancer, like a family history of the cancer, a history of smoking and heavy alcohol intake, and obesity.
To date, there has been no study to show that being diagnosed and possibly treated for Barrett’s esophagus prevents death from esophageal cancer. As with all disease screening decisions, make sure you know the odds and discuss it fully with your doctor.