When does long-term acid reflux become a serious issue?

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Q. I have had acid reflux for many years, but it is well controlled with a proton-pump inhibitor. However, I am concerned about long-term damage from my reflux, even though I feel fine now. Should I have an upper endoscopy to look for possible damage?

A. Long-term acid reflux can damage the esophagus and may lead to a condition known as Barrett's esophagus, which is a precursor to esophageal cancer. Barrett's affects about 3% to 10% of older men, but within this group the risk of developing esophageal cancer is only about four in every 1,000 cases. Over all, men with Barrett's are more likely to die from another cause.

An upper endoscopy is used to diagnose Barrett's. A long, flexible tube with a tiny camera attached to the end is inserted into your mouth and passed down your throat to enable a doctor to examine your upper digestive tract. (You are given a sedative to help you relax.) There is no consensus regarding who should have an upper endoscopy to look for Barrett's in the absence of worrisome symptoms, such as food sticking in your throat, weight loss, or pain from swallowing. In fact, most gastroenterology societies believe there is no definitive evidence that a screening endoscopy can help you live a longer, healthier life. However, men with multiple risk factors for Barrett's may consider an endoscopy to rule out this condition. These include age (over 50), race (Caucasians are at a higher risk), daily or nighttime reflux, hiatal hernia, and obesity.

— by William Kormos, M.D.
Editor in Chief, Harvard Men's Health Watch