Dr. Seper Dezfoli is a gastroenterologist and is board certified in liver disease and medical weight management at ProHealth Partners, a Medical Group, Inc.

Dr. Seper Dezfoli

New or persistent acid reflux, especially after age 50, may mean higher risk for esophageal cancer, particularly in people with other known risk factors.

New or Persistent Acid Reflux May Signal Esophageal Cancer Risk

Dr. Seper Dezfoli explained that long-term acid reflux — also called gastroesophageal reflux disease (GERD) — is the strongest risk factor for Barrett’s esophagus, which is the only known precursor to esophageal cancer.

“Long-term” means five years or more, including time with symptoms managed by medication. Other risk factors include being male, over 50, obese, a current or former smoker, white and non-Hispanic and having a first-degree relative with esophageal cancer. The more risk factors a person has, the higher their likelihood of developing Barrett’s esophagus.

Symptoms that may signal esophageal cancer include difficulty swallowing, food feeling stuck in the chest, unintentional weight loss or new, persistent acid reflux later in life.

Dezfoli is a gastroenterologist and is board certified in liver disease and medical weight management at ProHealth Partners, a Medical Group, Inc.

One of the strongest risk factors for developing Barrett’s esophagus, which is the only known precursor to esophagus cancer, is long term acid reflux, also known as gastroesophageal reflux disease, or GERD, as it's more commonly referred to as. We generally think of long term as five years but what's important to understand is that that's really including time both on and off medication. So, for example, if a patient has been on medications for five or more years to control their symptoms, that's considered long term GERD, even if their symptoms were controlled during that period. That just means that they've had the disease for five years and in necessitated medications.

So that's the biggest risk factor when it comes to Barrett’s esophagus; however, there are other risk factors that we consider nonacid risk factors and should be important to acknowledge. So those risk factors are being of male sex, being above the age of 50, obesity, current or past history of smoking, non-Hispanic white race and family history of esophagus cancer, especially in a first degree relative. So having three or more of those is what makes the risk factors go up for Barrett’s esophagus.

When we talk about acid reflux, that's the largest risk factor, but your risk of developing Barrett’s esophagus goes up incrementally as you have those additional risk factors as well. When it comes to esophagus cancer itself, the symptom that we usually are looking for is difficulty swallowing. So, patients will commonly say that when they swallow, they feel like the food is getting stuck in their chest, or they have to regurgitate the food back up. It's weight loss that's unintentional. So that means that you're losing weight, but you're not really trying to lose weight. It's coming off of you, and you don't really understand why.

Also, if you get brand new acid reflux that's just not going away, especially later in life. So, for example, let's say you've never had acid reflux, and your age 40, 50 and above, and then suddenly you're getting new acid reflux that you never dealt with before, and it's just not really going away. That can be another alarm feature that tells us that you may be having esophagus cancer.

Transcript has been edited for clarity and conciseness.

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Long-term gastroesophageal reflux disease (GERD) is the primary risk factor for Barrett’s esophagus, a precursor to esophageal cancer. Long-term GERD is defined as five or more years, including periods managed by medication. Additional risk factors include being male, over 50, obese, a smoker, white, non-Hispanic, and having a family history of esophageal cancer. The presence of multiple risk factors increases the likelihood of developing Barrett’s esophagus. Symptoms of esophageal cancer include difficulty swallowing, unintentional weight loss, and new persistent acid reflux later in life.

Expanding Access to Screening May Help Prevent Esophageal Cancer 

Before the introduction of minimally invasive approaches, such as EsoGuard, used to screen for Barrett’s esophagus, endoscopy was the only option for patients — an invasive procedure that requires sedation, time off work and insurance coverage, which can limit access, according to Dr. Seper Dezfoli.

Minimally invasive approaches, however, offer a more efficient, cost-effective alternative that could dramatically change how Barrett’s is detected and monitored. Identifying Barrett’s earlier is key, as 90% of patients diagnosed with esophageal cancer were never previously told they had Barrett’s. With broader use of EsoGuard, clinicians could screen more patients, intervene earlier and potentially prevent many cases of cancer.

CURE sat down with Dezfoli to discuss how the noninvasive EsoGuard test could expand access to screening for Barrett’s esophagus and help prevent esophageal cancer.

What are some of the key limitations of traditional endoscopy for screening Barrett’s esophagus, and how does a noninvasive test address these challenges?

: The need for having a non-invasive test to screen and diagnose for Barrett's [esophagus] has really long been overdue. Before we had EsoGuard, endoscopy was really the only method of screening patients for Barrett’s esophagus. Endoscopy is using an actual camera to physically go from the mouth and go down into esophagus and evaluate the esophagus.

Endoscopy is an invasive test. It requires anesthesia most of the times — it has its own risks, and it takes time. Patients have to take a day off of work, the doctor has to be involved, etc. Additionally, access can be an issue, so especially when you're considering insurance in the factor. Therefore, [non-invasive test’s] really changes that algorithm.

What we know is about 90% of patients who end up getting cancer were never diagnosed with Barrett’s esophagus. We also know that once Barrett's is actually identified, we have the tools to treat and survey those patients to lower the risk of going on to getting cancer.

So, if you think about it, the key here is screening, diagnosing Barrett's and then preventing esophagus cancer. And that's exactly what is EsoGuard does. The widespread integration of a tool like [this], which is cost effective, easy to administer and minimally invasive will completely revolutionize the way we even approach Barrett's and esophagus cancer. So right now, we're saying that 90% of patients who were diagnosed with esophagus cancer, were never even told that they have Barrett's or screened for it.

So, when you have something like is EsoGuard, it really fits nicely into that unmet need. It allows us to now implement that widespread screening, finding the patients that have Barrett's and then giving them the right treatment, surveying them, talking to them and educating them. [This is done in hopes that] we no longer will have that statistic where 90% of patients with cancer weren't even told to have Barrett, and we can bring that number down and hopefully prevent cancer.

Transcript has been edited for clarity and conciseness

Minimally invasive screening methods offer a more accessible, cost-effective way to detect Barrett’s esophagus early and help prevent esophageal cancer. 

Dr. Seper Dezfoli

New or Persistent Acid Reflux May Signal Esophageal Cancer Risk

Expanding Access to Screening May Help Prevent Esophageal Cancer

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