A&E consultant warns against dismissing heartburn after patient’s fatal oesophageal cancer

An emergency medicine consultant has warned that common heartburn should not be dismissed after a man with long-standing reflux presented to hospital with advanced oesophageal cancer that was too far progressed for surgery.

Prof. Rob Galloway, who works in A&E, described seeing a patient who had become unable to swallow food or water and arrived severely dehydrated. By the time he reached hospital, clinicians found an inoperable tumour of the oesophagus; palliative measures were the only option and life expectancy was measured in months rather than years.

Looking back at the patient’s history, Galloway said there were several missed opportunities for earlier diagnosis. The man had long-standing reflux and had been overweight for years. He reported drinking large quantities of fizzy drinks daily and had used over-the-counter lansoprazole to control burning pain for some time. When the symptom of food “sticking” — a classic red flag for an upper gastrointestinal problem — emerged, he was given higher doses of acid-suppressing medication rather than being referred for urgent endoscopic investigation.

Endoscopy, in which a small camera is passed through the mouth to examine the upper digestive tract and take biopsies when needed, can identify cancers and precancerous changes at a stage when curative treatment is still possible. Galloway described the test as “simple” relative to the potential lifesaving benefit of detecting disease earlier.

Clinicians and public-health advisers commonly identify chronic gastro-oesophageal reflux, obesity, smoking and excessive alcohol intake as factors associated with an increased risk of oesophageal malignancy. Persistent reflux can lead to changes in the lining of the oesophagus known as Barrett’s oesophagus, which is considered a precursor lesion for oesophageal adenocarcinoma and may warrant surveillance.

Galloway’s account highlights two linked concerns: that acid-suppressing medicines such as proton pump inhibitors can relieve painful symptoms while not addressing underlying disease, and that alarm symptoms — including new-onset difficulty swallowing, unexplained weight loss or vomiting blood — should trigger urgent assessment rather than escalation of symptomatic treatment alone. In his case report, the step taken was to increase the dosage of lansoprazole instead of arranging an immediate endoscopic examination.

Medical guidelines typically advise that patients with persistent or worsening reflux symptoms, especially when accompanied by swallowing difficulties, be evaluated by a general practitioner and considered for specialist referral. Early endoscopic assessment can permit diagnosis at a stage when surgery or other curative therapies remain options; delayed diagnosis reduces treatment choices and is associated with poorer outcomes.

Galloway said his work in emergency medicine often exposes him to the downstream consequences of missed opportunities in primary care and public awareness: cases in which relatively minor, long-standing symptoms are managed with intermittent relief but without investigation for underlying causes. He urged both clinicians and patients to take persistent reflux and any new swallowing problems seriously and to consider endoscopic investigation when red-flag symptoms appear.

The account reinforces longstanding messages from clinicians that persistent gastrointestinal symptoms deserve timely medical review. While many episodes of heartburn are benign and readily managed, the consultant’s case illustrates how a combination of risk factors, symptom masking by over-the-counter medication and delayed investigation can lead to advanced, incurable disease.

Patients who experience ongoing reflux, changing or worsening symptoms, or difficulty swallowing are advised to consult their general practitioner to assess whether urgent referral for endoscopy or other investigation is appropriate.