Bile and Barrett's Esophagus
A recent study in the Annals of Surgery has shown that it may be bile not stomach acid that contributes to the formation of esophageal cancer. In the study it was shown that bile caused specific changes to the lining of the esophagus that could potentially turn off normal esophageal cell growth and turn on the intestinal cell growth that is the hallmark of Barrett's esophagus. Researchers further theorize that the bile activates stem cells in the esophagus to act like intestinal cells, where bile is normally found.
If these theories prove correct it would mean changes in how we currently prevent Barrett's esophagus or esophageal cancers. The current thinking relies on treating with proton pump inhibitors (PPI‘s) to reduce the acid made in the stomach. However, if bile is the trigger for the cancerous changes not acid, PPI's may not prevent it. In these instances the best way to treat the issue would be surgical correction of the LES or "anti-reflux surgery".
These findings are still in the development stages but may provide us with new treatments to prevent what is a very aggressive cancer. If you are at a high risk for Barrett's esophagus it is important to discuss the issue with your doctor and keep on top of your check ups. Loosing weight if you are overweight and quitting smoking if you are a smoker can also help lessen your risk for the disease.