President Obama may have joked with reporters when they asked how his throat was feeling after he was diagnosed with acid reflux, but acid reflux can be a serious health threat. Up to 20% of Americans suffer from typical symptoms of gastroesophageal reflux two times per week, says Gilbert Simoni, a gastroenterologist in Thousand Oaks. For most of these people, the fiery sensation of heartburn is a painful nuisance. For an unlucky few, however, persistent acid reflux can lead to a deadly cancer of the esophagus.
Mindy Mintz Mordecai's husband, Monte Mordecai, was one of the unlucky ones. Mintz Mordecai herself had suffered from typical heartburn symptoms of reflux disease. But the only symptom her husband experienced was a choking cough when he laid down at night. She urged him to see a doctor, but he didn't think the cough was anything significant, so he ignored it.
"In the spring of 2007, my husband said that he felt something funny when he swallowed," recounts Mintz Mordecai, who is now the president of Esophageal Cancer Action Network. By the time he saw a doctor, it was too late — the funny feeling in his throat was an esophageal tumor. Despite surgery, radiation and two rounds of chemotherapy, Mordecai died within a year of his diagnosis, leaving Mintz Mordecai to raise their two young daughters.
In Obama's case, he had additional diagnostic tests, including a CT (computed tomography) scan, which was normal, statements said at the time.
While heartburn is the classic symptom of typical reflux, 65% of people with gastric reflux experience atypical reflux, which includes symptoms not normally associated with reflux disease: chronic cough, persistent sore throat, hoarse voice, persistent postnasal drip, chronic throat clearing, choking, dental erosion and even chest pain.
"This is the subset of patients that don't know they have reflux … and these people are more likely to develop complications because they don't know they have it," Simoni says. Their symptoms are also likely to be misdiagnosed as allergies or adult-onset asthma.
For both typical and atypical reflux, the underlying cause is the same: a loose valve between the stomach and the esophagus that allows gastric acid to splash up into the esophagus and larynx, irritating the throat, vocal cords and entrance to the lungs. Some researchers think that even fumes from the stomach can irritate the esophagus.
In 10% to 15% of people with gastric reflux, constant inflammation can cause cellular changes in the lining of the esophagus so it transforms into a structure similar to the lining of the intestines — a condition known as Barrett's Esophagus. Once this happens, patients who initially experienced heartburn will no longer be able to feel the burning sensation and will think the problem has gone away. But the condition is actually an indicator of pre-cancerous changes in the lining of the esophagus and, over time, greatly increases the likelihood of developing esophageal cancer.
Though rare, the type of esophageal cancer attributed to acid reflux is increasing at a faster rate than any other type of cancer in the U.S., with a fivefold increase over the last four decades, an increase that some theorize might be because of rising rates of obesity as well as an increasingly acidic diet. And because esophageal cancer has no early stage symptoms, most patients, like Mordecai, aren't diagnosed until the cancer is too advanced to effectively treat. The American Cancer Society projects that of 18,000 people diagnosed with esophageal cancer in 2014, 15,000 will die of that cancer. Most victims die within six months of diagnosis.
Unfortunately, Simoni says, there are no guidelines for esophageal cancer screening in the U.S.
"I recommend that anyone over the age of 40 have an endoscopy," Simoni says. "It's a five-minute test, the patient is asleep and we can get a lot of information."
Mintz Mordecai adds that anyone experiencing symptoms of typical or atypical reflux symptoms should see a doctor right away. "Being screened and knowing what your risks are could end up saving your life."