Firstly do not be ruled by diet and food lists. Most of them propagate myths and misconceptions.
Your stomach produces strong acid. The acidity of food entering it makes virtually no difference. If the stomach becomes too alkali it will produce more acid and vice versa.
It’s not so much what we eat as how we eat that’s important. Having said that, keep a food diary and see whether you have any particular trigger foods to avoid. (For me it was pastry. Tomatoes in any form have never been a problem.)
The myths grow anecdotally. Someone says a particular food was a trigger for them and others think it must affect them also.
Spicy foods are a point in mind. We all experience a burn at the back of the throat when eating a hot curry. If you have oesophagitis, you may also feel a burn as it passes over the affected area – in the same way as pouring lemon juice over a cut will hurt but not harm. (My charity has an annual curry evening instigated by our senior gastroenterologist. Qick advert. Anyone within range of Southampton, our next one is on (heart)Burn’s night, 25th January, for just £15.)
As many as 50% of those with Barrett’s report they have never felt the heartburn that is usually experienced with the acid reflux that caused it.
If you do want a book of recipes that have worked for other acid reflux sufferers, you can download a free copy of our “Cool Food” cookbook
The Prague classification is described at the bottom of this page.
It is composed of a c number, showing the width in centimetres of a cirumferential band, and an m number which shows the maximum extent of any tongues.
Read this page to learn the genesis of your Barrett’s.
All the best
- Preventing Esophageal Cancer With Diet
- 7 Ways to Reduce Your Risk of Esophageal Cancer
- Mayo Clinic Q and A: Determining foods to avoid when managing Barrett’s esophagus
- Barrett’s Esophagus
- What is Barrett’s Esophagus?
- Cause and Symptoms
- Things Patients Can Do
- The Future
Preventing Esophageal Cancer With Diet
For years, people have been looking for the perfect diet, the one that will help them shed pounds without sacrificing their favorite foods. But a good diet can do more than just help you maintain a healthy weight. It can also help prevent serious illnesses, like esophageal cancer, and there are a number of foods with this cancer-fighting ability. It’s just a matter of knowing what foods to incorporate into your diet and taking steps to do so.
Four Super Foods to Fight Esophageal Cancer
The right foods can help strengthen your body and give it the nutrients it needs to ward off esophageal cancer. Make sure to add plenty of these cancer-fighting foods to your daily menu:
- Colorful fruits and vegetables. Green and yellow fruits and vegetables offer the best esophageal cancer-fighting protection, especially such cruciferous vegetables as cauliflower, Brussels sprout, kale, broccoli, bok choy, chard, and cabbage. Make sure you get at least five servings of fruits and vegetables every day; create a rainbow of fresh fruits and vegetables with your menu to keep it interesting and to offer your body the best possible protection against esophageal cancer.
- Tea. Tea is rich in antioxidants, which are known to help prevent cancer, so it might be wise to drink a daily cup. Green tea is thought to be richest in these antioxidants, but black teas are also good. One Chinese study even showed that men who don’t drink tea (or drink very little) are twice as likely to have esophageal cancer as men who do drink tea.
- Black raspberries. Research conducted at Ohio State University has found that antioxidant-rich black raspberries called blackcaps may aid in protecting against esophageal cancer. The specific antioxidant that black raspberries contain so much of is called ellagic acid, which helps protect the body from inflammation — one of the potential causes of esophageal cancer. Most other berries also have high levels of antioxidants.
- Whole grains. Fill your plate with brown rice, whole grain bread, wheat pasta, oatmeal, and other whole-grain choices, which are rich in nutrients and antioxidants that may help ward off esophageal cancer.
Esophageal Cancer Prevention: Foods to Avoid
Just as there are foods that seem to help defend the body against esophageal cancer, some foods can leave the body more vulnerable to it. GERD (a type of heartburn known as gastroesophageal reflux disease) and Barrett’s esophagus (an esophagus with abnormal cells caused by GERD) are both major risk factors for esophageal cancer, and a number of foods can contribute to these conditions.
To reduce your risk of GERD, which could ultimately lead to Barrett’s esophagus and esophageal cancer, try to avoid foods that cause heartburn symptoms. These vary from person to person, but common culprits include:
- Citrus fruits, tomatoes and tomato-based foods, which are all high in acid ·
- Peppermint candies or flavoring
- Spicy foods
- Fried or fatty dishes
- Alcohol and drinks with carbonation
You should also limit your intake of red meats and processed meats as they have been linked to numerous types of cancers.
Your Esophageal Cancer-Fighting Diet
Your diet can’t completely protect you from esophageal cancer, but studies increasingly show that certain foods offer a cancer-fighting benefit. Fruits and vegetables are a staple for any healthy diet, and can protect against a number of illnesses and conditions beyond esophageal cancer. So be conscious about getting your five servings a day, along with foods that contain antioxidants, such as tea and whole grains, to help prevent esophageal cancer and ensure good health for many years to come.
And heartburn is a symptom of acid reflux, which occurs when stomach acid flows back up into your esophagus — the tube that connects the throat and stomach. In some cases, acid reflux progresses to gastroesophageal reflux disease (GERD), or a more serious form of reflux. Common signs of GERD include frequent heartburn, coughing, wheezing, chest pain and regurgitation — particularly at night.
While over-the-counter and prescription medicines are available, lifestyle changes can sometimes help those with only occasional acid reflux. The Mayo Clinic advises losing excess weight, eating smaller meals, and avoiding alcohol and nicotine. But dietary tweaks also can be key when trying to alleviate symptoms.
Here are five foods to try.
1. Bananas. This low-acid fruit can help those with acid reflux by coating an irritated esophageal lining and thereby helping to combat discomfort. Due to their high-fiber content, bananas also can help strengthen your digestive system — which can help ward off indigestion. One soluble fiber found in bananas is pectin, which helps move stomach contents through your digestive tract. And that’s a good thing — because food that sticks around will only continue to generate acid.
2. Melons. Like bananas, melons also are a highly alkaline fruit. They are a good source of magnesium, which is found in many medicines for acid reflux. Furthermore, melons have a pH of 6.1, making them only mildly acidic. Especially good are cantaloupe and honeydew melon.
3. Oatmeal. Like other high-fiber foods, oatmeal may help stave off acid reflux symptoms. Fiber not only promotes intestinal health, but it also reduces constipation and makes you feel full a long while after eating it. And, of course, when you feel full, you are less likely to overeat and therefore less likely to regurgitate what’s in your stomach into your esophagus. Enjoy your oatmeal with low-fat or almond milk, as both are low in fat and highly alkaline.
4. Yogurt. Like bananas, yogurt has a soothing effect that helps keep stomach discomfort at bay. It also contains probiotics, a type of good bacteria found in the digestive tract that gives a boost to your immune system. Being a good protein source means yogurt also improves your ability to properly digest food. Make yogurt even more impactful by adding in a bit of ginger, which can act as an anti-inflammatory in your system.
5. Green Vegetables. If you like green vegetables and have acid reflux, you’re in luck. Asparagus, spinach, kale and brussels sprouts all are highly alkaline, meaning they’re good for your stomach and digestive system. Being naturally low in fat and sugar, vegetables also help lessen stomach acid.
In the end, make sure to speak with your doctor if you have questions about what kinds of foods should be part of your diet. Some foods may help alleviate symptoms in one person but aggravate them in another. Make sure to work with your doctor to come up with an individualized plan that’s right for you.
7 Ways to Reduce Your Risk of Esophageal Cancer
Over the past 20 years, the number of esophageal cancer diagnoses has increased by more than 400 percent. The diagnosis is often deadly because it can go undiagnosed into the late stages, and, believe it or not, the most common type is usually caused by something as common as persistent heartburn.
If you’re wondering how to decrease your esophageal cancer risk, follow these tips:
Doesn’t it seem like exercise is on every disease prevention list? It’s a miracle-worker here, too. Physical activity reduces the risk of being overweight or obese, both of which can make gastroesophageal reflux disease and heartburn symptoms worse. A recent meta-analysis that analyzed four studies found the risk of esophageal cancer was 19 percent lower in the most active people compared with the least active. For esophageal adenocarcinoma, a specific type of malignant tumor, risk was 32 percent lower. The researchers concluded that obesity can increase the risk of esophageal cancer through high insulin levels and chronic inflammation, which exercise helps control.
2. Don’t ignore symptoms
If you have frequent heartburn, don’t just pop an antacid and go about your day. Talk to your health care provider about your symptoms. Your health care provider can diagnose any major issues, like Barrett’s esophagus, which increases the risk of cancer, and can prescribe medications that can effectively treat symptoms.
3. Quit smoking
Smoking does nothing good for your health, and it’s no different when it comes to esophageal cancer. Tobacco smoke is a known carcinogen. It can also inhibit saliva production, which your body needs. Saliva is a natural alkaline antacid that keeps your stomach and esophagus healthy.
4. Don’t lie down after eating
Lying down after a meal may seem harmless, but doing this can make heartburn worse, particularly if you have gastroesophageal reflux disease (GERD), also known as acid reflux. The valve between the stomach and esophagus doesn’t work properly in those who have this condition, and when you’re lying down, it can allow the contents of the stomach to seep into the esophagus. Wait a while before going to bed after dinner or taking a nap after lunch.
5. Sleep with your head elevated
Because the contents of your stomach can get backed up into your esophagus when you lie down, it helps to sleep with your chest and head elevated to prevent the problem. Raise the head of your bed 6 to 8 inches or use pillows or other products to find a comfortable elevated position.
6. Avoid or limit alcohol
Alcohol can irritate the esophagus and cause inflammation, which can worsen heartburn or GERD symptoms. Cut back on the amount you drink, and don’t drink and smoke, which can cause serious damage to your esophageal tissues.
7. Don’t assume anything if your symptoms stop
If you’ve experienced heartburn or GERD symptoms persistently and they suddenly stop, it’s not necessarily a good thing. It could mean that your esophagus has undergone changes that could lead to cancer, so get a checkup from your health care provider.
Mayo Clinic Q and A: Determining foods to avoid when managing Barrett’s esophagus
DEAR MAYO CLINIC: I was diagnosed with Barrett’s esophagus three months ago and was given some diet instructions, including eliminating alcohol and caffeine. Why is this necessary? Is it still possible for me to have an occasional alcoholic drink? Is decaffeinated coffee OK?
ANSWER: One of the main goals for the management of Barrett’s esophagus is controlling esophageal reflux. The diet guidelines you were given often can help control reflux and reduce its symptoms. But if symptoms don’t bother you when you have those foods or beverages, then you may not need to avoid them completely.
In Barrett’s esophagus, part of the normal tissue in the tube connecting your mouth and stomach — the esophagus — is replaced by tissue similar to the intestinal lining. Barrett’s esophagus is caused by gastroesophageal reflux disease, or GERD. Everyone who develops Barrett’s esophagus has, or has had, GERD. But not everyone experiences symptoms. In some people, the symptoms of reflux are readily apparent. They include heartburn, regurgitation, throat clearing, hoarseness, nausea or indigestion. But some people with Barrett’s esophagus don’t have reflux symptoms. Or they may have them for some time, but the symptoms go away.
The reason for lack of symptoms in some people is due, in part, to the way Barrett’s esophagus develops. The medical definition of Barrett’s esophagus is intestinal metaplasia of the esophagus. That means the normal cells of the esophagus, called “squamous cells,” are replaced by intestinal cells. “Metaplasia” means the replacement of one cell by another cell. When metaplasia happens, the first type of cell usually is more vulnerable to injury than the type of cell that replaces it.
In Barrett’s esophagus, the body decides to, in effect, wallpaper the esophagus with intestinal cells. This decision is due to GERD. The intestines are located just beyond the stomach, and the stomach produces a significant amount of acid. Some of the excess acid from the stomach passes into the intestine, and the intestinal cells aren’t irritated by it. So when intestinal cells replace squamous cells in Barrett’s esophagus, acid reflux isn’t as damaging to the esophagus. Because intestinal cells are more resistant to acid, some people with Barrett’s esophagus do not feel the effects of the reflux.
In people with Barrett’s esophagus who are affected by reflux symptoms, the symptoms may be triggered by certain foods, especially spicy, citric or hot foods, as well as other stimuli, such as alcohol and coffee. These foods and beverages have a tendency to cause symptoms because they reduce pressure in the lower esophageal sphincter, and that allows more acid to come into the esophagus. They also may act as an irritant, and they can affect the way the stomach empties, both of which can lead to symptoms.
The severity and frequency of symptoms caused by diet varies quite a bit from one person to another. For example, whereas coffee may predictably cause reflux symptoms in some people, in others, it causes no symptoms at all. And in some cases, if certain diet choices cause symptoms before the patient is treated with an acid-suppressing medication, symptoms may go away with those medications. The most common medicines used to suppress acid are proton pump inhibitors and H2 blockers.
When certain foods and beverages cause reflux symptoms, it would be wise to avoid them or use them sparingly. If they do not cause symptoms, or if acid-suppressing medications prevent symptoms, then it’s likely that you don’t need to completely eliminate those foods and beverages from your diet, and you may use them in moderation.
Before you decide which foods and beverages to avoid — or not — due to Barrett’s esophagus, check with your health care provider to make sure that your choices are a good fit for your health overall. — Dr. David Fleischer, Gastroenterology, Scottsdale, Arizona
Heartburn is a burning sensation felt behind the breastbone and sometimes in the neck and throat. It is caused by stomach acid refluxing or splashing up into the esophagus — the muscular tube that connects the throat to the stomach. At the lower end of the esophagus where it enters the stomach, there is a strong muscular ring called the Lower Esophageal Sphincter (LES). The LES should remain tightly closed, except to allow food and liquid to pass into the stomach. Heartburn occurs when the LES opens at the wrong time.
Almost everyone has this occasionally, and it is nothing to be concerned about. However, heartburn that is severe or that occurs frequently over a long period of time can be harmful. This is known as Gastroesophageal Reflux Disease (GERD). If GERD is untreated, there is constant acid irritation to the lining of the esophagus, and complications can occur. About 1 in 10 patients with GERD are found to have a condition called Barrett’s esophagus. Those with Barrett’s esophagus are at slightly increased risk to develop cancer of the esophagus.
What is Barrett’s Esophagus?
The cells lining the esophagus differ from those lining the stomach or intestines, mainly because they have different functions. They also have a distinctly different appearance, so it is usually easy for a physician to tell them apart when examining the esophagus and stomach. Normally, there is an area at the end of the esophagus that marks the border between the cells of the esophagus and those of the stomach. Barrett’s esophagus is the abnormal growth of intestinal-type cells above this border, into the esophagus.
The Barrett’s cells may help protect the esophagus from acid exposure. It may protect the normal tissue in the esophagus against further damage by GERD. This may explain why the symptoms of GERD seem to lessen in some patients with Barrett’s esophagus. Unfortunately, these tissue changes may be a forerunner of cancer of the lower esophagus, known as adenocarcinoma. Another type of cancer of the esophagus is squamous cell cancer. It is more often formed in the upper esophagus and is increased in those with a history of alcohol and tobacco abuse. This type of cancer appears to be decreasing in the population, while the rate of adenocarcinoma is increasing sharply, especially in white males.
In time, the Barrett’s cells may develop abnormal changes known as dysplasia. Over a period of perhaps two to five years, the dysplasia may progress from low grade, to high grade dysplasia, and finally to cancer. Fortunately, this happens only in about 1-5% of patients with Barrett’s esophagus.
We believe that the length of Barrett’s a person has impacts their risk so a person with five inches of Barrett’s is at higher risk than someone with one inch.
Cause and Symptoms
For unknown reasons, Barrett’s esophagus is found three times more often in males than in females. In some instances, Barrett’s esophagus appears to be congenital (present at birth). However, current evidence is strong that in most instances, it develops as a result of longstanding GERD.
Patients with Barrett’s usually have symptoms similar to those produced by chronic GERD, such as heartburn and reflux of stomach acid into the mouth. Some Barrett’s patients may also suffer from other complications of GERD, such as esophageal peptic ulcers and stricture — narrowing of the esophagus that comes from scarring. These facts are why it is important for patients with these symptoms to see their physicians regularly.
Diagnosis of Barrett’s esophagus requires an examination called upper endoscopy or EGD (esophagogastroduodenoscopy). A barium x-ray is not accurate for detecting Barrett’s esophagus. An EGD is done with the patient under sedation. The physician examines the lining of the esophagus and stomach with a thin, lighted, flexible endoscope. Biopsies are performed, taking pieces of tissue to be examined under a microscope for abnormal cells and to assess their potential of becoming malignant. These changes include the term indefinite dysplasia where the pathologist may be uncertain of the changes. In this circumstance, medical treatment is intensified and repeat biopsies are performed in 6-12 months. When dysplasia is definite, some type of definite correction is often necessary.
Things Patients Can Do
Currently, there are no medications to reverse Barrett’s esophagus. However, it appears that treating the underlying GERD may slow the progress of the disease and prevent complications.
Following are some things the patient can do to help reduce acid reflux and strengthen the LES.
- Avoid eating anything within three hours before bedtime.
- Avoid smoking and tobacco products. Nicotine in the blood weakens the LES.
- Reduce consumption of fatty foods, milk, chocolate, mints, caffeine, carbonated drinks, citrus fruits and juices, tomato products, pepper seasoning, and alcohol.
- Eat smaller meals. Avoid tight clothing or bending over after eating.
- Review all medications with the physician. Certain drugs can actually weaken the LES.
- Elevate the head of the bed or mattress 6 to 8 inches. This helps to keep acid in the stomach. Pillows by themselves are not very helpful. Wedging pillows under the head tends to bend the body at the waist which can push more fluid back up into the esophagus.
- Lose weight if overweight. This may relieve upward pressure on the stomach and LES.
A certain category of drugs called proton pump inhibitors are the main tool used to reduce stomach acid. There are a number of these medications available. Some of the more common ones include Prilosec (omeprazole), Prevacid (lansoprazole), AcipHex (rabeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Dexilant (dexlansoprazole) taken once or twice a day. All of these are equally effective. Other acid reducing drugs such as Zantac, Pepcid, Axid, and Tagamet are also available. Reglan (metoclopramide) is a drug that can strengthen the LES and so help.
Certain patients with GERD may need surgery to tigthen the area around the LES. This type of surgery is called fundoplication. It is now done by laparoscopy. Laparoscopy is minimally invasive surgery, performed with small incisions at the naval and a few other points in the upper abdomen.
In the past few years, a number of treatments have come available to eradicate the Barrett’s cells. There is active research being done to determine which patients would benefit the most. It is important to remember that the vast majority of people with Barrett’s never develop cancer. Patients who develop dysplasia though now have available a number of treatments to include cryotherapy and radio frequency ablation. Talk with your physician to decide what is best for you.
A diagnosis of Barrett’s esophagus requires regular monitoring by a physician. While it is thought that controlling GERD reduces the risk of developing cancer, this has not yet been definitely proven. Therefore, the physician must perform regular endoscopy exams and biopsies to look for dysplasia. Just how often these exams are repeated depends on how far the disease has advanced. If cancer is found, surgery to remove the lower esophagus is usually necessary.
There are numerous newer treatments constantly being studied. These involve the destruction of the abnormal cells in the esophagus without the need for major surgery.
Barrett’s esophagus is a condition that may develop as a result of chronic GERD. Barrett’s tissue growing in the esophagus appears to be the body’s defense against continued stomach acid irritation. Yet, this tissue does not belong in the esophagus, and for a small number of patients, it increases the risk of developing cancer. While medications do not reverse Barrett’s, the likelihood of developing cancer and complications can probably be reduced with a combination of diet, lifestyle changes, medication, and/or surgery. A regular program of endoscopic examination and biopsy is essential to monitor the Barrett’s tissue. There are also a number of treatments available for those patients who develop dysplasia. By working closely with a physician, patients can expect good control of both GERD and Barrett’s, and an excellent long-term outcome.
Oct. 12, 2011 — People with Barrett’s esophagus, a complication of heartburn and acid reflux disease, are at risk of developing a deadly kind of cancer at much lower rates than doctors previously believed, a new study shows.
The study is published in the New England Journal of Medicine.
Researchers collected information on more than 11,000 people in Denmark who were diagnosed with Barrett’s esophagus to see how many would go on to develop an aggressive cancer called adenocarcinoma of the esophagus.
In Barrett’s esophagus the lining of the esophagus, the muscular tube that connects the throat to the stomach, abnormally changes after repeated exposure to stomach acid.
The condition may affect as many as 1 million American adults. It is most commonly diagnosed in men who are white, overweight, and over age 50.
Previous studies have found that Barrett’s esophagus increases the risk of getting cancer of the esophagus. This study found that the risk of cancer, while still elevated, is much lower than previously believed, about 0.12% per year. That equals about one case of cancer diagnosed each year for every 860 people with Barrett’s. That’s about an 80% lower risk than previously believed.
Those findings echo another study published earlier this year in the Journal of the National Cancer Institute. That study, of 1.7 million people in Northern Ireland, estimated the yearly risk of cancer of the esophagus in people with Barrett’s to be around 0.13%, or one case of cancer each year for every 769 people diagnosed with the condition.
Researchers say the findings mean that it may not be helpful or cost-effective for doctors to give some people with Barrett’s regular, invasive tests to keep looking for cancer.
“I think it’s going to be a landmark study,” says Heiko Pohl, MD, a gastroenterologist and associate professor of medicine at Dartmouth Medical School and Dartmouth Medical Center in Lebanon, N.H. Pohl studies the risks and benefits of cancer screening tests. He was not involved in the current research.
“This is going to help us get a better understanding of the magnitude of the problem, what Barrett’s really means,” he tells WebMD.
Many patients with Barrett’s are offered surgery to freeze or burn off the abnormal tissue, even if they don’t have any signs of cancer.
“Hopefully this study will put a little brake on the whole hype,” Pohl says.