Progression Of Gerds to Cancer?

Digestive health
1

Hi all. My name is Curtis. Im 42 and I live in the U.S.,South Carolina. My first post so wanted to say hello before I bring up my issues and questions.

I have had reflux probably about 18 years. First signs of it were lpr symptoms pretty much outside a stomach burn when I was first put on gerds meds back then. Was put on protonix 20 mg and worked like a charm. Probably took it about a year and for the longest time didnt need it and was symptom free for years outside occasional regurgitation or very mild heartburn which an over the counter antacid took care of. My issues however started to get chronic after needing to take nsaids for degenerative cervical disk pain. My gerds got bad while taking them to the point I switched to tylenol instead. But by that time the gerds was here to stay. Was put back on ppi which has been changed up several times the last two years because they help for a while but then stop. Well in the last month I developed the classic lpr symptoms again along with what has now become daily heartburn. Actually it seems to alternate. Some days its the lpr and some its the chest pain of heartburn. Never had a scope for gerds. But have been set up appointment with GI doc to discuss if one is needed. Emergency told me I had esophagitis. My doc now has me taking 40 mg protinix and 150 mg ranitadine at night before bed. Just started that last week. Stopped coffee,cut way back on colas until I can boot them also. Scared of scope findings. Not really the scoping it self. My question is this. What has been studied to determine length of time from gerds to cancer in the general population? Im seeing many people who have had gerds for 30 plus years and no cancer even though they may have esophagus issues. Hoping I fall in to that catergory of people.

2

Did want to mention by symptom free that was a pretty long span of time probably 10 years. Also the nsaid use stopped around 2013. Havent touched them since. But that was the start of this gerd situation up until now. The progression was fairly slow to this esophagitis. Just last week put on the 40 mg protinix and ranitadine at night. Have elevated my bed and began cutting out the diet offenders. Probably to eatly to tell much yet on those changes. Ive read it can take upwards of 8-12 weeks to heal from esophagitis reflux. So looks like I wont know much until after being scoped. I estimate about two months out on that based on time to get to see gi doc from my lower gi scope last year.

3

Sorry I don't know the full answer to your question. But I can tell you I had 5 clear endoscopies then the last one showed + for Barrett's. I knew if the acid continued to back up bad things were sure to happen. So I guess the question you should have is can you control the acid and if so, you should be okay. If not, medication, live style changes, diet changes and possibly surgery might be needed.

4

I intend on doing my best to control it with lifestyle changes,plus medicine the docs give me. Not sure what the end result will be but I will do my part. I dont drink or do any drugs,intend on dropping a few pounds to get closer to my prime bmi and watch what I consume. Im just afraid to much time has elapased. I never knew reflux was a danger. Never had doctors tell me it was. In fact they always treated it like a stubbed toe. I feel they were neglegtful in their actions. If I were to have known the dangers years ago I could have stayed on top of it.

5

Please stop worrying Curtis. The odds of cancer are very low and many of us here have Barretts. You have in my view worked out yourself what you have to do and it is of course change your lifestyle. Just as an aside the Nsaids are more likely to give you ulcer problems than throat. There are dozens of non nasty ways out there to reduce pain. BUT please oh please get an endo so you know what you are up against. I dont know but it sure sounds like simple gastritus has triggered your flare up. Remember you are NEVER alone here!

6

Thanks Rex. And I am scheduled to meet with gi doc on the 22nd if a slot is open. Either way I am going to push hard for the scope.

7

Progression from GERD to cancer, if it is going to happen, takes the following route:

1. GERD

2. Probably about 1 in 10 with GERD get Barrett's Oeosphagus. About 1 in 500 with non-dysplastic Barrett's per year will get cancer.

3. Next stage, if progression occurs, is Low Grade Dysplasia. Risk of progression about 1% p.a. If diagnosed with Barrett's with dysplasia have it ablated to minimise any risk of preogression.

4. Next would come High Grade Dysplasia with risk progression of 6% per year.

HGD used to be known as "carcinoma is situ" and may be graded on the cancer scale as Tis - which is below T1, neoplasia - the earliest stage of cancer

Anything upto and including T1 can usually be removed by ablation therapy.

Risks of progression over lifetime from Non-Dysplastic Barrett's gives  reasonable chance over 20 years so if non Barrett's, just GERD, risk is about 200 years.

Your chances of getting cancer are, in other words, not worth worrying about. You're more likely to harm yourself through worry.

I know I've had reflux problems all my life and can trace particular symptoms of GORD and extra-oesophageal reflux for over 60 years.

For the last 21 years, Ive known I have Non-Dysplastic Barrett's and it hasn't changed in all that time and I am confident it will never change. (We're learning more about this every year and it seems, although I have the genetic potential to develop Barrett's, I probably don't have that gene combination to permit progression or it would probably have shown changes by now,)

So discover your own particular triggers - the foods that cause you problems (and it may not be coffee). Make lifestyle changes to reduce reflux because it takes reflux + acid + bile to make the cellular changes to your oesophagus. And your acid suppressants will reduce the acid. Not a lot you can do about the bile except for reducing fatty foods and processed meats.

(Figures quoted above provided by statistics unt of Cancer Research UK)

8

Thank you Barrets. I have visited your site the past week and it is very informative. I will be downloading the book available and look forward to the read. I do know for a fact that any carbonated cola is a trigger. As soon as I drink it I get warm feeling in chest the chest pain. Coffee I have not fully tested yet. But seeing as I have not drank it in a few days,no need to bother going back. I need to learn my foods and which give me issues. Im sure dairy products do. Always have. Issues at both ends lol. So thats my Starting point.

9

I find it very surprising that your doctor has not sent you for an endscopy, its pretty standard here in the UK or have you not had one done because you have no medical insurance and would have to pay for it yourself. An endscopy may be expensive but it really would put your mind at rest.

Its times like this that people in the UK forget how lucky they are with the NHS. Yes you may have to wait but there is no bill at the end.

As others have said, you probably have nothing to worry about, hope it all works out for you

10

I have medical care through greenville hospital system and an outside clinic. They do good by me. Its just that out of all the doctors Ive seen since being told I had gerd,none even thought of it as a big deal. Old out dated thinking. My new doctors arent that way.

11

I am taking esomeprazole 20mg and ranitidine 300 mg daily for very painful throat and chest radiating through to my back.  I just dont know what to eat, even water is difficult.   Do you have any suggestions for me. I am also prediabetic, due to taking prednisolone, so have to be careful of carbohydrates.   Is there anything else which can help with the pain?   I would be really grateful for your help.

12

I think you'll need to discuss this with your doctor. Pain relief can be a problem for those of us producing too much acid. You're actually on quite a low drug regimen but I used to experince problems with ordinary plain water, too. (For me the fundoplication worked to reduce reflux and render me med free.)

13

Im taking one protonix 40 mg in the morning and ranitadine 150 mg at night and so far only partial results if any really. I think your dose msy be to low. According to what I have read people like us should be on twice daily ppi maximum dose. So even my dose is low. I am going to speak with my doc about it on the 22nd and see if everything merits a change. Some of us are refractory patients,meaning we dont respond well to the meds and may heal slower also. In some cases 8-12 weeks or longer depending on our ability to control the reflux.

14

Thanks for your prompt reply.  Did you find that there was any particular food or drink that didnt aggravate the acid?   I dont have a very good reaction to PPIs, so can only take a low dose.

15

Protonix (pantoprazole) 40mg is equivalent to 20mg Nexium (esomeprazole).

You don't have to take the medication in 2 doses. It just makes it easier to assimilate. Best time to take PPIs is 30 minutes before breakfast but that's only to get into a habit and for the food to help ensure the tablet has reached the duodenum before dissolving.

16

We're all different in how our bodies react to food so it's a case of experimentation. I personally found one of the easiest things to enjoy is one which most people are told to avoid - ice cream. Not the full Cornish dairy cream stuff but the cheapest vanilla that probably has little or no dairy product in it. But I'm not offering it as a recommendation since dairy products can cause problems for so many.

If you actually do find you react to PPIs, have you tried H" blockers, eg Ranitidine instead? They're not as effective as PPIs and you'd probably need 300mg dose.

17

Thats interesting. I always take the pantoprazole in the morning. But never followed up with a meal to ensure it is absorbed properly in the duodenum. Seemed to always work before but doesnt mean that is the case now for me. I will have a light breakfast the next few days to see if it makes a difference.

18

For the pain I take 2 500 mg tylenol around one half hour before bed,also have my bed elevated at the head to help keep the acid down at night. The tylenol does help. I sleep fairly well and usually pain free outside of an occasional night where I had already had heartburn before bed. Sometimes I take a dose during the day but not to often. Could give it a try. Works ok for me.

19

Just a heads up on tylenol. I absolutely swore by this stuff when it first came out but one does have to be very carefull with dicky stomachs. I ended up with an ulcer which isnt a whole lot of fun either. Many here take Melatonin for sleeping as it appears to be fairly safe and not addictive. I tried it with some success but didnt want to go down the path of using aids to get to sleep. I suppose this goes back years when I had a lot of trouble getting off long term Valium use. Slept like a log though!!! How are you going overall?

20

Like you I went to one of the newer forward thinking young doctors today he he rather amazingly started the session with an accupuncture treatment. Too early to tell if this has done anything. It is really refreshing to see normal doctors branching out into new fields dont you think? This guy is also super focussed on food. His mantra is food got you into this mess and whole foids will get you out of it with a little bit of help from meds and supplements. What a find!