What are the complications of gastroesophageal reflux disease (GERD)?

Occasional heartburn is very common and usually not serious, but chronic gastroesophageal reflux disease (GERD) can have long-term complications, especially if it is not treated. Inflammation and persistent stomach acid in the esophagus can cause open sores or ulcers and bleeding, a condition known as esophagitis. Over time, the inflammation in the esophagus can also lead to a buildup of scar tissue that can narrow the esophagus and cause swallowing difficulty. This is known as esophageal stricture. In some people, the damage to the esophagus causes the cells in the lining of the esophagus to change, leading to a precancerous condition known as Barrett's esophagus. This increases the risk of esophageal cancer.

Complications of gastroesophageal reflux disease (GERD) include esophageal ulceration, stricture (narrowing), Barrett's esophagus (a precancerous condition), esophageal cancer, chronic cough, loss of dental enamel and laryngitis. Other possible complications include asthma and recurrent ear infections.

Symptoms of GERD can include a burning sensation in the chest, a sour taste in the back of the throat, chronic cough and sometimes even difficulty swallowing.

Complications related to gastroesophageal reflux disease (GERD) develop due to the prolonged exposure of stomach acid to the esophagus lining which is not protected from the harsh stomach acidity.

The most common complication of GERD is reflux esophagitis—inflammation of the esophagus from acid. Chronic inflammation predisposes one to Barrett’s esophagus, a condition where the lining of the esophagus mutates in an attempt to protect itself from the acid exposure. The development of Barrett’s esophagus then increases the risk of developing esophageal adenocarcinoma (cancer of the lower esophagus). One last complication is the development of a stricture (narrowing) of the esophagus which prevents solid food and even liquids from easily passing into the stomach.

The many complications of GERD are why patients should be evaluated and monitored by a gastroenterologist. In particular, a gastroenterologist should discuss the appropriate time for evaluating the esophagus by endoscopy (EGD) to ensure no complications have or will occur.

Although simple acid reflux is uncomfortable, it doesn't usually pose a danger to healthy individuals. Half to three-quarters of people with reflux disease have mild symptoms that generally clear up in response to simple measures. Over time, however, serious problems can develop when gastroesophageal reflux disease (GERD) goes untreated. These complications can include narrowing (stricture) of the esophagus, erosion of its lining, precancerous changes in its cells, and esophageal ulcers.

If left untreated, gastroesophageal reflux disease can lead to serious health complications. In this video, Sharmila Anandasabapathy, MD, a gastroenterologist, discusses the damage that reflux disease can cause in your esophagus.

The following are the complications that can occur with gastroesophageal reflux disease (GERD):

• Erosive Esophagitis
• Esophageal ulcers
• Esophageal strictures
• Aspiration pneumonia and asthma
• Poor quality of life
• Barrett’s esophagus (and this can lead to esophageal cancer in a small percentage of cases)

GERD irritates the esophagus and can lead to a narrowing and/or ulceration of the esophagus, a risk of Barrett's esophagus, and a slightly increased risk of esophageal cancer.

Gastroesophageal reflux can cause ulcerations and erosions of the esophagus. If this continues to occur over a long period of time it can scar the esophagus and cause a narrowing or stricture. In a small group of patients, it can cause the normal lining of the esophagus to be replaced by abnormal cells. This is known as Barrett’s esophagus and can lead to esophageal cancer. Reflux can also cause asthma when acid goes high enough into the esophagus and is aspirated into the lungs.

Reducing the amount of acid and the amount of reflux can prevent these complications. This can be done by taking acid blocking medicines such as omeprazole (Prilosec). Reducing the amount of reflux can be done with weight loss, elevating the head of the bed by about 6 inches, and avoiding foods that cause reflux. 

In severe cases of GERD surgery may be recommended.

Complications of acid reflux can include dysphagia (difficulty swallowing), regurgitation and an increased risk of cancer. This is due to progressive damage to the esophagus, resulting in inflammation, ulceration and possible scarring with narrowing. In addition, these symptoms may be indicative of esophageal cancer. All of these symptoms merit seeing a doctor for further care. At that time, the individual should undergo an upper endoscopy to evaluate the source of the problem. Barrett's esophagus is a condition where the lining of the esophagus changes because of chronic inflammation, generally due to GERD. In the setting of chronic acid exposure, the cellular structure of the lower esophageal lining changes to look more like the cells lining the intestine. Barrett's esophagus itself has no specific symptoms, but this change can increase the risk of esophageal adenocarcinoma (a type of esophageal cancer). Barrett's esophagus can be readily detected during an upper endoscopy but must be confirmed by biopsies. The intent is to diagnose this condition, treat it medically and follow it over time before cancer has a chance to develop. If biopsies detect dysplasia (a precancerous change in tissue), then your doctor will recommend either close endoscopic surveillance (doing endoscopies at regular intervals with biopsies), endoscopic therapy or surgery. Endoscopic therapy may include removal of Barrett’s with dysplasia using endoscopic mucosal resection, which can remove abnormal tissue in the esophagus without damaging the rest of the esophagus. Endoscopic ablation of Barrett’s tissue can be done with either radiofrequency ablation, which destroys and kills cells by heating them, or cryotherapy, which destroys cells by freezing them. After treatment, the esophagus grows back a normal healthy lining. Your physician will determine which treatment option is best for you.

Besides the unpleasant sensation of tasting your food on the way up, GERD also burns your esophagus—in the same way the sun burns your skin. After a burn, it takes a couple days to heal, but if the burning happens over and over, it means you're burning the tissues and more likely to develop cancer there (just like repeated sun burns increase your risk of skin cancer).

Taking half a full aspirin or two baby aspirin (you want 162 mg) with a glass of water decreases this risk by about 35 percent.