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The 1 Surprising GERD Symptom That Has Nothing To Do With Your Gut
GERD (or gastroesophageal reflux disease) is a digestive disorder that causes acid from the stomach to flow up into the esophagus (aka the tube that helps food move from your mouth to your stomach). As you might imagine, this condition can cause some pretty uncomfortable GI symptoms, like heartburn, chronic cough, and nausea—especially after you've just finished a meal or if you lie down too quickly after eating. But you might experience one symptom that has nothing to do with your gut: back pain.Back pain can stem from a ton of different sources. And if you regularly deal with acid reflux, it's possible that GERD could be the culprit. "It's not a common phenomenon, but I've had patients who've talked about it," says Supriya Rao, M.D., a gastroenterologist with Tufts Medicine in Boston, MA. Here's more about why exactly it happens and what you can do about GERD-related back pain.
Experts In This Article
When you have back pain from GERD, you're dealing with something called referred pain—or pain that's felt in a part of your body beyond the actual source of the pain. "A lot of nerve endings in the esophagus, where reflux occurs, get crisscrossed with nerve endings in the back muscles. So people might feel pain because of that crosstalk, often in between the shoulder blades," Dr. Rao explains.
GERD-driven pain might extend to other areas too, like your neck, jaws, or arms, according to a paper published in Medscape General Medicine—which might freak you out a little bit, especially if you've never experienced it before. "People can get scared and think it's cardiac-related," Dr. Rao says. (FYI: pain caused by GERD isn't a sign of a heart problem. But if the pain is severe or persistent and you're not sure what you're dealing with, it's a good idea to see your healthcare provider for testing and treatment, if necessary.)
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Are there any long-term complications of GERD-related back pain?Referred pain from GERD isn't going to do damage to your back or shoulders. But aside from just being unpleasant, unmanaged GERD can potentially cause some problems in the long run.
The biggest risk is that all that acid eventually starts to damage your esophageal tissue. That could result in long-term inflammation or scarring that narrows your esophagus, which in turn could make it harder to swallow, Dr. Rao says. The tissue damage can also lead to Barrett's esophagus, a condition where your esophageal cells start to sustain harmful changes that raise the risk for esophageal cancer, notes the Mayo Clinic. So, if you're experiencing heartburn and can't figure out why, seeing your healthcare provider sooner rather than later can help you receive the treatment you need to prevent symptoms from worsening and causing potential complications.
How to treat GERD back painSpeaking of treatment, you may be relieved to hear that several treatment options can help reduce GERD symptoms, including back pain. "Treating the reflux and changing your lifestyle around, all of those things can help [relieve symptoms'," Dr. Rao says.
Here are some expert-approved treatment strategies:
Preventing back pain from GERD ultimately comes down to keeping that reflux at bay as much as possible. You can prevent painful symptoms by sticking to the same lifestyle changes that are recommended for treating GERD, Dr. Rao says. However, if lifestyle adjustments aren't enough, taking medication to control your acid reflux can be helpful. Many people wonder if you have to take the medications forever, especially when living with a chronic condition like GERD, however, "it's often possible to get off the meds once you initially get the GERD under control, provided you're willing to stick with healthy lifestyle habits," says Dr. Rao.
When to see a healthcare providerYou should let your healthcare provider know if you're experiencing frequent acid reflux or other symptoms of GERD, especially if you've been trying to manage the problem on your own without success. They can run tests to look at the lining of your esophagus (like an upper endoscopy) to help give you an accurate diagnosis for GERD or check to see if treatment is working.
Also, keep in mind that while GERD can cause back pain, it's also possible for people with GERD to have back pain for an entirely unrelated reason. So it's also worth letting your provider know if your back continues to hurt even after your GERD is being managed. That helps you and your healthcare team explore other potential culprits of back pain and discuss treatment options to help you feel better.
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This Pill-Size Diagnostic Seeks To Prevent Thousands Of Esophageal Cancer Deaths
Esophageal cancer is one of the most deadly cancers — so why doesn't the healthcare industry have better tools to prevent the disease?
Lucid Diagnostics is on a mission to solve that problem. The company — which was launched in 2018 as a subsidiary of medtech company PAVmed — has developed a quick, office-based test that can detect precancer in people with heartburn at risk of developing esophageal cancer.
By focusing on preventing esophageal cancer, Lucid is fulfilling an unmet need, pointed out CEO Lishan Aklog. When it comes to early detection programs, this cancer type has seen significantly less activity than other cancers, such as breast, lung, colon and cervical, he said.
Lucid's test for esophageal precancer, called EsoGuard, is primarily meant for patients with gastroesophageal reflux disease (GERD), commonly known as heartburn or acid reflux. People with GERD are considered to be at high risk for developing esophageal precancer and cancer, Aklog noted.
"The key to preventing 16,000 [annual] cancer deaths is to not detect it at an early stage. That's not very effective because Stage 1 esophageal cancer has an almost 50% mortality rate," he explained. "In order to actually have an impact and prevent these deaths, you have to pick it up at the precancer stage."
If a physician identifies that their patient has early precancer, they usually just monitor the patient with an endoscopy every three years, Aklog said. If a physician determines that their patient has late precancer, the care team usually then performs an endoscopic ablation, a procedure that destroys the abnormal precancer cells before they can progress to cancer, he added.
Before Lucid's test, the only way for physicians to identify esophageal precancer was via endoscopy, Aklog stated.
Endoscopies are not convenient, though, he noted — explaining that they are invasive, require an intravenous anesthetic and usually necessitate time-consuming preparation and recovery.
"Endoscopy has failed as a screening methodology. The missing link in all of this — so that we could actually prevent these tragic deaths — was a simple, effective, outpatient office-based test that can detect a precancerous condition and put people on surveillance and a treatment program to prevent cancer. And that's what we have," Aklog remarked.
Lucid's device — which received FDA clearance in 2019 — is the size of a common vitamin pill, and it is attached to a thin catheter. The device collects cells from a patient's esophagus when swallowed, which are then analyzed for genetic markers associated with esophageal precancer and cancer.
The whole process of collecting the sample takes "a minute or two," Aklog declared.
There are at least 30 million patients each year who should be tested for esophageal precancer but are not, he said. These are people who are over age 50 and have two risk factors — which include things like obesity, smoking, heavy alcohol consumption and chronic GERD.
The complexity of endoscopies means that many physicians fail to recommend them and many patients opt not to go through with them — but Lucid's test has the potential to solve this issue with its convenience, Aklog said.
He noted that Lucid is the only company selling a commercial technology that can perform noninvasive biomarker testing for esophageal precancer.
Aklog also said that he is optimistic Lucid's product will be approved for coverage by Medicare and commercial insurers "quite shortly."
Photo: Lucid Diagnostics
Achalasia Linked To Esophageal Cancer: Case Report
Achalasia is primarily caused by the degeneration of the myenteric plexus in the esophageal wall, leading to impaired relaxation of the lower esophageal sphincter (LES) and loss of esophageal peristalsis. Although the exact etiology is not fully understood, it is believed to involve autoimmune mechanisms and viral infections. Key pathological features include the absence of peristalsis, LES hypertonicity, and symptoms such as dysphagia and regurgitation. In this condition, the esophagus fails to contract and move food toward the stomach, while the LES remains tightly closed, preventing the passage of food into the stomach. Consequently, food stasis in the esophagus leads to common symptoms like difficulty swallowing and regurgitation.
Patients with achalasia typically present with progressive dysphagia to both solids and liquids, regurgitation of undigested food, chest pain, and weight loss. The diagnosis is often confirmed through esophageal manometry, which shows absent peristalsis and elevated LES pressure, and barium swallow studies, which reveal a dilated esophagus with a narrowed gastroesophageal junction (bird-beak appearance).
Case presentationAchalasia is associated with an increased risk of esophageal squamous cell carcinoma (SCC) and, less commonly, esophageal adenocarcinoma. Several studies have highlighted this elevated risk, noting that chronic inflammation and food stasis in the esophagus lead to prolonged irritation and inflammation, which predispose the esophageal mucosa to malignant transformation. Additionally, the altered esophageal environment caused by food stasis can result in changes to the microbiota, further contributing to carcinogenesis. Furthermore, the risk of esophageal cancer increases with the duration of achalasia, with patients who have had the condition for over 10 years being at particularly higher risk.
Case 1A 53-year-old male with a history of achalasia presented in January 2022 for treatment of progressive dysphagia to both solids and liquids, which had been ongoing for approximately two years. His symptoms included regurgitation of undigested food, occasional chest discomfort, and unintentional weight loss of 4 kg over the previous six months. Diagnostic esophagogram and high-resolution manometry confirmed the diagnosis of type II achalasia, with absent esophageal peristalsis and incomplete relaxation of the lower esophageal sphincter. He underwent peroral endoscopic myotomy (POEM) for symptom relief.
Initially, the patient reported improvement in dysphagia symptoms, with an ability to tolerate both solid and liquid food without difficulty. However, by April 2022, he developed significant gastroesophageal reflux disease symptoms, characterized by frequent heartburn, acid regurgitation, and occasional epigastric pain. A proton pump inhibitor was prescribed, and lifestyle modifications were advised, but his reflux symptoms persisted, although somewhat controlled with medication.
In May 2024, during a routine follow-up, the patient reported worsening reflux and the new onset of retrosternal discomfort, along with a recurrence of mild dysphagia. Physical examination was unremarkable, but given the recurrence of symptoms, an upper gastrointestinal endoscopy was performed. The endoscopy revealed a friable, ulcerated lesion located 25 cm from the incisors, which was suspected to be malignant. Biopsy specimens were obtained from the lesion.
Histopathological analysis confirmed the presence of esophageal squamous cell carcinoma ( Fig. 1 ). The lesion was staged using endoscopic ultrasound and computed tomography scans, which revealed local infiltration but no distant metastases. Additional laboratory findings, including a complete blood count, liver function tests, and tumor markers (e.G., carcinoembryonic antigen, SCC), were within normal limits, except for a slightly elevated SCC antigen level. Positron emission tomography was planned for further evaluation.
This case highlights the potential long-term risk of esophageal cancer following POEM in patients with achalasia, especially in the context of chronic reflux. Early recognition and surveillance in high-risk patients may be crucial for timely intervention. Further therapeutic options, including surgical resection, chemotherapy, and radiation therapy, are under consideration for this patient, depending on the staging results.
Case 2A 51-year-old female with a known history of achalasia presented with progressive dysphagia and intermittent retrosternal pain, particularly when consuming solid foods, over the past year. She had previously experienced episodes of regurgitation and occasional heartburn, but these symptoms had become more pronounced in recent months. Her medical history was otherwise unremarkable, with no prior history of gastroesophageal reflux disease or family history of malignancy.
On physical examination, the patient was in good general condition, with no significant weight loss or other systemic symptoms. Laboratory investigations, including a complete blood count, basic metabolic panel, and liver function tests, were within normal limits. Due to the progressive nature of her symptoms, an upper gastrointestinal endoscopy was performed.
Endoscopy revealed an esophageal lesion located approximately 25 cm from the incisors, appearing as a raised, irregular mucosal area with mild friability. Biopsies were taken from the lesion for further pathological evaluation.
Histopathological examination of the biopsy specimens revealed high-grade intraepithelial neoplasia. Immunohistochemical staining was performed to further characterize the lesion, and strong nuclear positivity for P53 was observed in approximately 85% of the cells, indicating a high likelihood of tumor suppressor gene mutation. The Ki-67 index showed high expression, with a labeling index of 95%, suggesting rapid cell turnover and aggressive cellular proliferation ( Fig. 2 ). No evidence of invasive carcinoma was identified at this stage, and the lesion was confined to the mucosal layers, consistent with high-grade dysplasia.
Given the high-risk pathological features, the endoscopic ultrasound was performed to assess the depth of invasion. No submucosal invasion was detected, and there was no involvement of regional lymph nodes. A computed tomography scan of the chest and abdomen showed no signs of distant metastasis.
This case illustrates the potential progression of achalasia to premalignant lesions, as demonstrated by the presence of high-grade intraepithelial neoplasia. The strong P53 positivity and elevated Ki-67 index further underscore the aggressive nature of this dysplastic lesion. Close surveillance and timely intervention, including endoscopic or surgical resection, are being considered to prevent progression to invasive esophageal carcinoma.
ConclusionsAchalasia significantly increases the risk of esophageal cancer, particularly squamous cell carcinoma. The chronic inflammation and food stasis associated with achalasia are major contributing factors to this heightened risk. Effective management of achalasia, combined with vigilant surveillance for early signs of cancer, is essential in reducing the morbidity and mortality associated with this condition. Future research should focus on identifying the molecular mechanisms linking achalasia to esophageal cancer and developing targeted therapies to prevent malignant transformation.
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The study was recently published in the Cancer Screening and Prevention .
Cancer Screening and Prevention (CSP) publishes high-quality research and review articles related to cancer screening and prevention. It aims to provide a platform for studies that develop innovative and creative strategies and precise models for screening, early detection, and prevention of various cancers. Studies on the integration of precision cancer prevention multiomics where cancer screening, early detection and prevention regimens can precisely reflect the risk of cancer from dissected genomic and environmental parameters are particularly welcome.
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