Can inflammation of the esophagus from systemic lupus lead to cancer? If so, what do you suggest to reduce the risk?

R.B.

Systemic lupus erythematosus (SLE) is a chronic (long-term), debilitating autoimmune condition most commonly affecting the joints, skin, kidneys and nervous system. Patients are often chronically ill and require steroids or other immunosuppressive medications to control their disease. SLE can involve many other systems in the body, with the gastrointestinal tract being a common site for problems.

One part of the gastrointestinal tract that SLE frequently affects is the esophagus, usually leading to difficulty in swallowing. This symptom occurs because inflammation and weakness of the esophageal muscle leads to poor contraction. Thus, food does not easily pass down the esophagus into the stomach, producing the sensation of food being stuck in the esophagus. SLE can also lead to heartburn and regurgitation, as well as ulcerations of the esophageal lining. These symptoms are treated as they would be in any person who suffers from gastroesophageal reflux disease (GERD).

In any chronic inflammation and ulceration of the esophagus, whether associated with SLE or typical GERD, there is a potential for the healing process to result in Barrett's esophagus. In Barrett's esophagus, the cells that normally line the esophagus are replaced by cells that resemble those that line the intestine. Over time, cancer can arise in this unusual tissue. Thus, a diagnosis of Barrett's must be followed by periodic biopsies to check for any changes that may signal early cancer.

Whether treatment of Barrett's can actually reduce the risk of cancer is a matter of debate. There have been conflicting reports from studies regarding whether medications or surgery for GERD can help to reverse Barrett's. At this time, the best advice for someone with SLE-related esophageal inflammation is to have close follow-up with a gastroenterologist to determine further therapeutic options.