By: Jean Johnson for Reflux1
”The problem with all this science jargon is that to understand it you have to concentrate way harder than I want to do,” said Rudolph Pearson of Phoenix, Ariz. with a laugh. You know, I’m retired now. I did my share of thinking when I was younger. I do have pretty bad acid reflux, though. So far there’s no Barrett’s or esophageal cancer, but you never know. If there’s any way you can make whatever this latest business is about easy to grasp, I’m all for it.”
Think sequence, is what we said to Pearson. While NOX5 might not be a term one can cozy up to, the enzyme present in our bodies could hold a key to understanding exactly how it is that acid reflux can give rise to esophageal adenocarcinoma or cancer.
|Know the facts about esophageal cancer: Esophageal cancer is three to four times more common in men than women. |
Because the disease is usually diagnosed at a late stage, it has a high death rate.
While esophageal cancer is a concern in the United States, rates are 10 to 100 times higher in Iran, northern China, India and southern Africa.
Smoking, heavy alcohol use, eating diets low in fresh fruits and vegetables and being overweight are all behaviors that increase the risk for esophageal cancer.
“Now that we know the sequence, we may be able to slow down or even block the progression of cancer by blocking these different steps,” Weibiao Cao, M.D., MSc, told Lifespan after the Journal of Biological Chemistry published results of Brown Medical School assistant professor of medicine’s results.
“This may have therapeutic value if we can block this particular enzyme, NOX5, in Barrett’s esophageal cancer cells.”
“Yes,” said Pearson. “Certainly I can relate to that. It means they’re actually on the hunt for something that might give patients some relief. Sounds good to me.”
Acid Reflux, Barrett’s Esophagus and Esophageal Cancer
The reason Cao is talking in terms of therapeutic value is that as Pearson understands, acid reflux is a widespread condition than can lead to cancer of the esophagus. Also, in some, but not all patients who have acid reflux (GERD or gastroesophageal reflux disease) the condition known as Barrett’s esophagus can develop.
Barrett’s is an often symptom-less problem in which changes in the tissue lining the esophagus are seen. While not all people with Barrett’s have long histories of heartburn or reflux, the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK) notes that Barrette’s “is found about three to five times more often in people” with reflux than it is in those that don’t suffer from repeated episodes of heartburn.
Further according to NIDDK, “the risk of developing adenocarcinoma is 30 to 125 times higher in people who have Barrett’s esophagus than in people who do not.” The NIDDK also notes that adenocarcinoma or esophageal cancer “is increasing rapidly in white men,” an increase the institute speculates may be “related to the rise in obesity and GERD.”
Sequence, Acid Reflux, and Cancer – the Long and the Short of It
For Pearson and others like him, we’ve summarized the science below in both long and short forms.
Cao’s research examines how acid reflux increases NOX5 or what he terms “the expression of this enzyme. That is important, he writes, because NOX5 stimulates the “production of hydrogen peroxide which is known to cause DNA damage, and cell growth in Barrett’s cells.”
“The role of acid is controversial. But we show that by exposing cells to acid for short periods of time, that affects a particular enzyme, triggering a chain of events that possibly leads to cancer of the esophagus,” Cao told Lifespan. “Now that we have a better understanding of the signaling pathway, we can possibly identify who is at risk of developing cancer by determining the levels of this enzyme.”
There we have it. Heartburn after a big meal leads to elevated levels of NOX5 that gives hydrogen peroxide production a nudge. And while hydrogen peroxide in the bottle might be great for any number of things, when too much of it is loose in the body, DNA damage occurs and cancer cells arise.
“Ah,” Pearson said. “I relate to that. There’s nothing like a short course, even though to my mind it’s amazing that a simple sequence like that would take so long to understand.”
Pearson laughs again and then qualifies his comment. “But of course the body is a complicated system. Its goings on can run the best and the brightest of us round in circles – or at least through a good old English maze. Mother Nature is quite the task master.”
Risk Factors for Esophageal Cancer
We checked with the Mayo Clinic, and researchers there point out that smoking, heavy alcohol use, eating diets low in fresh fruits and vegetables and being overweight are all behaviors that increase the risk for esophageal cancer.
Pearson shares that he worries that he is a prime candidate. He is almost 70 and continues to smoke and drink more alcohol than he knows he should.
“That’s how my generation is, I guess – or at least most of them. I think I’m one of the youngest left. But in those days that’s what we all did. Everybody smoked and had our cocktails at night,” he said. “We didn’t even think about it being hard on us. And you know, once you get those habits going, it’s pretty tough to leave them behind as you get older.”
Added to his use of tobacco and alcohol, Pearson realizes his eating habits aren’t the best.
“That’s right. I’m a meat and potatoes man. My wife likes to try out some of these new vegetables once in awhile, but I tell her don’t bother to make them for me. With my dinner I like a salad with Roquefort dressing. And by salad I don’t mean all those limp green leaves that the stores are trying to pass off on everyone these days. I like iceberg lettuce like my mother always used. It’s crunchy and crisp.
“I do eat bananas for snacks or sometimes with a bowl of corn flakes and milk. And there’s lemon meringue pie – it’s my favorite and I like fresh pie whenever my wife will make it, which is almost once a week. Otherwise, it’s mainly orange juice when I get a cold,” he said. “And, of course, there’s grapefruit juice with my vodka. That goes down real easy.”
Pearson beat us to the punch on the delicate subject of weight. “I’ve always run to the hefty side. I see that now when I look back at pictures of myself. It’s funny how when you’re a little chunky early on, you just get heavier as you age,” he said. “My doctor did tell me that I needed to back away from the table a little earlier or try getting more exercise. He doesn’t have my old dogs, though – or my appetite. And my wife – she’s such a good cook and takes a lot of pride in her meals. She’d feel bad if I didn’t enjoy what she makes.”
Back to acid reflux and cancer, though, Pearson says that he does hope esophageal adenocarcinoma is not his fate. “I hear it’s not a very nice way to go. Apparently it gets hard to swallow, and people lose a lot of weight,” he said, laughing some more. “Now wouldn’t that be the cat’s lousy pajamas – getting cancer and having it not matter any more how much you ate, but being so sick you couldn’t enjoy what you like in your remaining days.
“Now that I think about all this in those terms, I really do hope the scientist is making some headway here well. All his ‘think sequence’ business – if he does have the links in the chain figured out pretty good, like he says, maybe if he keeps tinkering he really can locate some ways to help people. I’m sure there’d be a long line of grateful people wanting to thank him. I just hope I don’t end up one of them that’s standing around wishing and hoping.”