Working in A&E, I see not just the immediate emergencies, but the consequences of what happens when little symptoms are ignored, lifestyle risks are overlooked, or when the health system misses chances to step in.
I recently saw a man who was no longer able to swallow food and water and was badly dehydrated.
He had undiagnosed oesophageal cancer and by the time he came through our doors, it was too late: the tumour was inoperable. His future was measured in terms of months, not years, and all we could do was ease his pain.
And yet, looking back at his story, there was so much that could have been done to prevent this. He’d been overweight for years (he also drank litres of fizzy drinks every day) and had reflux for as long as he could remember.
But instead of seeing his GP, he relied on over-the-counter lansoprazole – tablets that mask the burning pain brilliantly, but don’t stop the damage the acid can cause over time.
Then came the point where food began to stick in his throat – the classic red flag. Instead of an urgent endoscopy, where a tiny camera is inserted to examine the upper digestive tract, he was given increased doses of the acid-suppressing pills for his symptoms.
By the time the camera test was finally done, the cancer had advanced beyond treatment.
It was heartbreaking and it left me frustrated, because cancers of the gullet and stomach may not be as common as bowel cancer, but they’re far deadlier.
When people say they’ve got ‘indigestion’ they usually mean either acid reflux or gastritis, which are very different, writes Professor Rob Galloway
Having problems swallowing (dysphagia), feeling or being sick, heartburn or acid reflux and symptoms of indigestion, such as burping a lot, can all be signs of oesophageal cancer
Globally, oesophageal cancer is the seventh most common cancer, yet it’s the sixth biggest killer; stomach cancer is fifth for cases and fourth for deaths.
Only one in five patients with oesophageal cancer makes it to five years, and only one in four with stomach cancer. Compare that with bowel cancer, where more than half of patients are still alive after five years, and you see how merciless these diseases are.
The part that gets me is how often the patient’s story starts with something people shrug off – heartburn or ‘a bit of indigestion’. Because when you normalise symptoms, you may miss your chance of preventing a deadly cancer.
When people say they’ve got ‘indigestion’ they usually mean one of two very different things: acid reflux or gastritis.
Both are incredibly common, although a lot of people – even doctors – tend not to even think about gastritis.
Yet it’s on the rise: a new study in the International Journal of Medical Sciences found that 38million people worldwide had gastritis or duodenitis (a similar condition affecting the digestive system), and the number is heading towards 51million by 2050.
Acid reflux and gastritis have similar symptoms and can both lead to cancer but, significantly, require quite different treatments.
Acid reflux occurs when acid splashes up into the gullet or oesophagus.
Being overweight, especially carrying weight around the middle, makes acid spill upwards. Alcohol, smoking, large or late-night meals, fatty or spicy food, chocolate, and fizzy drinks all pile on the risk by irritating the valve at the bottom of the oesophagus.
Certain medications, such as blood pressure tablets, can also relax the valve and make things worse.
Fizzy drinks are a perfect storm. Carbon dioxide forms acid, and the bubbles themselves create pressure in the stomach, forcing acid up into the oesophagus: essentially our bodies were not designed to drink fluids with bubbles in them.
A major study published in the European Journal of Nutrition in June, using data from 167,600 UK participants over 13 years, found that those who drank more than one sugary fizzy drink a day had a 7 per cent higher risk of reflux. For diet versions, the risk was 12 per cent higher.
The symptoms of acid reflux include a burning pain in the chest (heartburn), sour-tasting acid coming back up into the mouth and sometimes a stubborn cough.
If this becomes chronic, that constant burn can inflame the gullet and then scar it, leading to precancerous changes – called Barrett’s oesophagus – and, in some cases, to oesophageal cancer.
Gastritis is quite different – this is where the lining of the stomach becomes inflamed and damaged.
Instead of acid splashing upwards, it attacks the stomach wall because the organ’s natural protective shield has been eroded. Common causes include infection with a bug called H. pylori, painkillers such as ibuprofen, heavy alcohol use or smoking. Symptoms include upper tummy pain, nausea, bloating or feeling full very quickly.
And just like reflux, if gastritis is left unchecked it can progress through stages of inflammation and cell change, eventually leading to stomach cancer.
Both reflux and gastritis can cause internal bleeding, which may show up as black stool or vomiting blood if the bleeding is sudden, or as tiredness from anaemia if the blood loss develops slowly.
It’s vital that if you have symptoms of acid reflux or gastritis you don’t just keep taking over-the-counter medications.
If acid reflux lasts for longer than four weeks despite tablets, or if new warning signs appear – such as food getting stuck, pain when swallowing, unexplained weight loss, or signs of bleeding – then further investigation is needed.
And if you have the symptoms of gastritis for more than six weeks, or your symptoms are joined by the new warning signs (the same as for acid reflux), this needs checking, too.
Endoscopy is one of the simplest but most powerful tools we have to stop these cancers before they take hold.
It’s a 20-minute test that can pick up Barrett’s oesophagus in people with reflux, and the inflamed patches that can lead to stomach cancer in cases of gastritis. If trouble is spotted early enough, we can often treat it during the same procedure – burning away abnormal cells or cutting them out.
But crucially there’s new evidence that we can prevent cancers forming in the first place if someone has gastritis.
A landmark analysis published a few weeks ago in the journal Gastroenterology confirms that a simple test could save your life.
Based on more than 20 studies, involving tens of thousands of patients, this showed that eradicating H. pylori in otherwise healthy adults cut the risk of stomach cancer by about a third. In those who already had early precancerous changes in their stomach lining, the benefit was even greater, almost halving the risk.
Most striking of all, the overall number of deaths from stomach cancer fell by more than a fifth.
The message of this study is as practical as it is urgent. If you’ve got ongoing indigestion, bloating or stomach pain, don’t just live on tablets. Ask your GP about a breath or stool test for H. pylori. If it’s positive, a short course of antibiotics and antacids will not only make you better, it could be the difference between life and death.