Caitlin Whyte (Host): This is Community Connect presented by TGH. I'm Caitlin Whyte. Joining me is Dr. Christopher DuCoin, Professor of Surgery, Chief of the Division of GI and General Surgery, and Vice Chair of Surgery at Tampa General Hospital. Dr. DuCoin, welcome.

To start our conversation, can you tell us what is GERD and who does it affect?

Christopher DuCoin, MD MPH FACS: Yeah, that's a great question. So GERD, or gastroesophageal reflux disease, is really common in the United States of America. It actually affects about 30 to 35 percent of our population across the country. When we start coupling with other comorbid conditions such as obesity, it can get up as high as 60%. But what GERD is, is really just reflux or heartburn.

It's when the acid that's produced in our stomach, which is totally normal and everybody does it, and creates acid. It's when it refluxes up into your lower esophagus causing a extreme discomfort really like a burning sensation, hence the name. Yeah, GERD is something that's really common and, but it's scalable.

You know, there's some patients that have classic GERD, what we think, like, some issues or symptoms after a red sauce or maybe chocolate or coffee, but then there's other people who it's life debilitating towards where the regurgitant really affects them every day, every meal and really can affect and damage the distal esophagus.

Host: Great. And can you also tell us about how GERD is related to esophageal cancer?

Christopher DuCoin, MD MPH FACS: You know, it's tricky GERD and its relationship to esophageal cancer. So even to take a step back I think what we do with a lot of cancer is to try and define the underlying cause and smoking and drinking are, are two of the common ones we hear about But then there's other things gastric cancer, you know, sometimes there's food we eat, which can affect that, but esophageal, in particular, what we call adenocarcinoma, or the glandular carcinoma that forms at the bottom of the esophagus, it is only thus far in our literature related to reflux disease.

We know that as GERD progresses and is more difficult and challenging and damages that distal esophagus, the patient, those cells change within the patient. They become precancerous, Barrett's esophagus, and then they eventually turn into cancer. Now, it takes time, and everyone's different, but definitely GERD is something that, while affecting so many people, isn't something we should just brush under the rug, or take a single medicine, and and not manage the chronic nature of the disease.

Host: Hmm. Well, focusing more on GERD, what are the current treatment options and do we treat this at all surgically?

Christopher DuCoin, MD MPH FACS: So a GERD treatment has changed quite a bit over the last, I'd say like 15 to 20 years. The main treatment was, was surgical. It was, we would remove part of the stomach that produced all this acid and we cut these nerves called the vagus nerves or cranial nerve 10 to try and reduce acid.

But what happened was we had PPIs or proton pump inhibitors, what you, you hear trade names such as Prilosec, Pepcid, which really are incredible medications. And they do a fantastic job of suppressing the acid that's produced in the stomach. But to a certain extent, they can kind of mask the disease also because while the acid is being suppressed, if you think about it, that sensation that you got from the GERD, wasn't just the acid produced in the stomach. It was the acid refluxing up in the esophagus. So while the, the medications might suppress that acid in the stomach, they didn't change anything about still the reflux or regurgitant that's going up, so there are still things we need to worry about, and that's possibly when additional surgical options can come in to anti reflux operations where we actually suppress the reflux or regurgitant up. But with the advent of PPIs or proton pumping inhibitors, we see a drastic decrease in gastric ulceration, gastric perforation, and they've been incredible medications. And there's new ones out all the time, which is, it's fascinating, but they are very expensive and to a certain extent, a burden on our healthcare system.

One would think that surgery would be more expensive, but data shows that at a certain point, these lifelong chronic medications, not only are very expensive, masking the symptoms, can also produce side effects too. We get a lot of patients who just want to be off their chronic meds and they'll look to surgery or anti reflux surgery as an option.

Host: And then outside of medicine Doctor, are there any other treatment options for GERD?

Christopher DuCoin, MD MPH FACS: Yeah. So, anti reflex operation is a fantastic choice. We do it minimally invasive, small incisions. A lot of the times we use the robotic platform now. Operations are most of the time, less than an hour, could be outpatients stay where you go home the same day, maybe one day in the hospital. And the results are phenomenal, if done in a high volume center where we've got about 98 to 99 percent of patients, GERD free, they're able to sleep flat at night, eat the foods they love. They come off their antacid medicine, drastically reduces any risk of esophageal cancer in future. My one thing is, let's make sure you go to a high volume center with best outcomes that are reporting quality.

Host: And how about esophageal cancer? What are the current treatment options for that?

Christopher DuCoin, MD MPH FACS: Again, the current treatment options are really intense and they depend on the stage of the disease when it's diagnosed. And I'd probably say this is true for most all cancers. The earlier we detect them, the better our treatment options are going to be. It kind of sounds like a no brainer, but the problem with esophageal cancer is we usually only sense it, what we call dysphagia or difficulty swallowing, when that tumor has grown into the wall of the esophagus.

Once it's grown into the wall of the esophagus, it's usually a stage 2 or stage 3. It's chemotherapy, radiation. Then followed by surgery. The surgery is a really big operation. I'm very proud and excited to say that we offer minimally invasive approaches and we've got multiple options for surgical resection of the esophagus.

But they're all resection of the esophagus, which is a big deal. It's the conduit between your mouth and your stomach. And we actually use the stomach to rebuild it. We'll turn the stomach into a tube and really create like a new esophagus with that stomach. Big operations, right? And I love doing them.

But at the end of the day, if I could prevent them and never do another one, I would. And that really comes back to screening. And if we had better screening methods and better screening options where we could detect the disease earlier, before it grew into the muscle, before it was at stage 2 or stage 3.

What we'd really want to do is try and get it at early stage 1. Then we can resect it trans orally, just with an endoscope down the patient's mouth and remove it in that manner. Massively different operations. Endoscope down the mouth probably takes an hour to do or so. What we call an Ivor Lewis or an esophagectomy takes sometimes up to six to eight hours to do those are the big surgical options. Patient can be in the hospital for weeks and they carry clearly more risk.

So really for me good esophageal cancer treatment is good esophageal cancer screening, and really trying to detect these diseases earlier. And I never mentioned really stage four. Stage four is clearly when the disease is spread metastatically. And there's not much options there outside of chemotherapy, but we do have new to the scene something called immunotherapy, which kind of speeds up your own immune system, which is absolutely fantastic, in addition to chemotherapy.

Host: And Doctor, to wrap up our conversation today, what can we do to help further research, and even cure esophageal cancer?

Christopher DuCoin, MD MPH FACS: For me to cure esophageal cancer is to detect it early. So I think raise awareness around esophageal cancer, shed light on GERD and gastro esophageal reflux disease. If someone has GERD, go to a high volume center where anti reflux operations have about a 98 percent cure rate of all reflux where you come off your acids.

 If someone is male, over the age of 55, has a family history of gastric or esophageal cancer, smoking, I would recommend screening. And we have multiple screening options that are outpatient. It doesn't require an endoscopy. It's much like Cologuard for colorectal surgery. Outside of that, just remember April is Esophageal Cancer Awareness Month.

 Try and support all cancer but esophageal cancer in April. And if you ever know anyone who's been treated or has suffered from esophageal cancer, just give them a hug. It's a tough disease process and if they beat it, they're a warrior. If they've lost someone to it, let's remember them and let's try and change everything through additional research.

I'd say let's support esophageal cancer research just as much as we support the other cancer researches out there. Let's try and make an impact and a difference.

Host: That has been Dr. Christopher DuCoin. I'm Caitlin Whyte, and this is Community Connect, presented by TGH.

 For more information about the TGH Digestive Disease Institute, Please visit tg.org/ddi. To learn more about cancer treatment options available at the Tgh Cancer Institute, please visit tgh.org/cancer.