Diagnosing and treating esophageal reflux is what I do for a living. Every. Single, Day. Arguing with you is pointless given your firm belief that your command of Google trumps my 4 years of medical school, 5 years of residency, and 35 years of specialty practice.

Frankly, I just don’t have the energy to try to correct such a vast array of misconceptions and misinterpretations of medical literature.

Familial tendency is a pretty small component of the population who gets esophageal adenocarcinoma (about 5%), but because the prognosis is so poor, it’s clinically relevant. Family history of esophageal cancer or Barrett’s esophagus will certainly be part of the history that your doctor obtains. If he/she doesn’t ask you about that then you are seeing the wrong doctor.

Right now, it’s not clear exactly what the inherited component is...is there a familial tendency to have GERD, to have Barrett’s esophagus, or to have esophageal adenocarcinoma? Probably all three, but it really doesn’t matter from a clinical standpoint. If you have recurrent and persistent GERD, you should get an endoscopic exam with attention to the lower esophagus, with particular attention to narrow-band imaging of it, and possibly biopsy or optical endomicroscopy, in order to identify Barrett’s esophagus if present. This is all especially true of the population most at-risk for esophageal adenocarcinoma... obese (BMI>30) white males between the ages of 50 and 70 with a history of recurrent reflux symptoms. Especially if there’s a family history of GERD, Barrett’s esophagus, or esophageal adenocarcinoma. Surveillance is also important. Currently, screening interval is debatable, anywhere from 3 to 5 years for those at risk. There's no debate that EGD findings from 11 years ago are likely irrelevant to what might be going on in one's esophagus today.

Interestingly, most people these days are relatively accepting of their doctor’s recommendation to embark on a colonoscopy screening schedule but many still tend to pooh-pooh the suggestion that they should get an upper GI endoscopy. “aah...it’s just a little heartburn doc...no big deal”. I can tell you...colon cancer is a walk in the park compared to esophageal cancer. Sadly, there are still many doctors, including gastroenterologists, that are pretty clueless on the issue too. “Aah...you just have a little GERD. Here, take these pills for awhile”.

To clarify the genetic screening concepts Ray9 mentioned, for the most part there’s no consensus on methods or practicality of genetic screening. It’s expensive, not readily available, and it’s not clear that genetic screening will have any more impact on the disease than a careful family history. Those things could change in the future, once we know more and with additional studies, but for right now there's no need to head down to your local genetic testing station.

Reflux occurs when intragastric pressure exceeds lower esophageal sphincter pressure. So anything that increases intragastric pressure (like obesity), or anything that decreases LES pressure (like alcohol or cannabis) will likely cause reflux. Obesity’s role in reflux relates to its effect on the increased intragastric pressure that it causes, and to the hiatus hernia displacing the LES that it tends to promote. An obese person drinking alcohol or smoking weed is likely to get reflux. A thin person might get reflux too, but perhaps less likely due to decreased intragastric pressure. There are many other factors too, including a variety of esophageal conditions/diseases and some physiologic conditions of the stomach and esophagus. The answer to your question is that a person with normal BMI is generally less likely to get reflux from drinking/smoking than an obese person doing the same.

The most common cause of non-cardiac chest pain is esophageal spasm or dysmotility. The most common cause of esophageal spasm/dysmotility is reflux. A person coming to me with those symptoms...the standard process would be an EGD to evaluate the anatomy of the esophagus and stomach (hiatus hernia, stricture, erosive esophagitis, Barrett’s esophagus, esophageal cancer), ambulatory pH testing to determine the extent of reflux and how it correlates with symptoms, and high resolution manometry to evaluate esophageal and LES performance (spasm, hypercontractility, outflow obstruction). If your gastroenterologist hasn’t recommended this process for your long-standing reflux and your chest symptoms for which you “eat Pepcid like candy”, especially if it’s been more than 3 years, then I would suggest getting a second opinion.