What is gastroesophageal reflux disease (GERD) and what can happen if it's not controlled?
Symptoms of gastroesophageal reflux disease (GERD) include a burning sensation under the chest and regurgitation (bringing up) of stomach fluid. Sometimes, patients wake up during the night because of symptoms. Less commonly, GERD can cause vomiting, bleeding, or difficulty swallowing.
If left uncontrolled, chronic (long-term) heartburn, or GERD, can result in serious problems including esophagitis, Barett's esophagus, strictures, and esophageal cancer.
When stomach acid repeatedly comes into contact with the lining of the esophagus, it causes injury, which can include erosions or ulcers. Esophagitis may cause symptoms such as heartburn, chest pain, trouble swallowing, or bleeding.
Barrett's esophagus is a condition that develops in some people (about 10%) who have long-term GERD. It is a risk factor for cancer of the esophagus.
Damage from acid reflux can cause abnormal changes in the lining of the esophagus. The normal cells that line the esophagus are replaced with a type of cell not usually found in the esophagus. These abnormal cells are similar to those normally found in the lining of the small intestine.
People who have had heartburn for years may be at risk for Barrett's esophagus. Barrett’s esophagus is typically diagnosed in people who are middle-aged or older. It is more common in men than in women.
Barrett's esophagus is diagnosed with a test called an upper endoscopy (also known as an EGD) to look at the lining of the esophagus and obtain a biopsy (tissue sample) for examination. Many experts recommend endoscopy to check for Barrett's esophagus in people who have risk factors, such as long-standing heartburn (more than 10 years), white race, male gender, and being overweight. A screening test for Barrett’s is not recommended for the general population of patients with heartburn or reflux.
Although uncommon, Barrett’s esophagus may lead to esophageal cancer in some patients. Roughly one in 300 people with Barrett's esophagus will develop esophageal cancer each year. Because of the cancer risk, people with Barrett's esophagus are usually checked regularly with endoscopy.
The goal of treatment of Barrett’s esophagus is to prevent further damage by stopping acid reflux from the stomach. Proton pump inhibitor medications like Omeprazole®, Nexium®, Protonix®, Prevacid®, Prilosec®, and Aciphex® and others are the mainstay of treatment. These drugs reduce the amount of acid produced by the stomach. In some patients, surgery to tighten the sphincter or "valve" between the esophagus and stomach may be an option to prevent reflux.
Doctors are also now using newer techniques called ablation to destroy the abnormal tissue. Ablation is performed with endoscopy using various methods including radiofrequency wave energy, laser, and cryotherapy (freezing the tissue). This procedure is usually reserved for patients in special situations, such as those with a high risk of developing esophageal cancer and who are unable to go through major surgery.
Sometimes the damaged lining of the esophagus becomes scarred, causing narrowing of the esophagus. These strictures can interfere with eating and drinking by preventing food and liquid from reaching the stomach. Strictures can be treated by dilation, in which an instrument gently stretches and expands the opening in the esophagus.
Cancer that begins in the esophagus is divided into two major types:
- Squamous cell carcinoma: This type of cancer begins in the special cells—called squamous cells—that line the esophagus. This cancer usually affects the upper and middle part of the esophagus. Risk factors include smoking and heavy alcohol use.
- Adenocarcinoma: This type of cancer usually develops in the lower part of the esophagus. It can arise from Barrett’s esophagus.
Esophageal cancer, in its early stages, often has no symptoms. Difficulty swallowing is the most common symptom of esophageal cancer. As the cancer grows, it narrows the opening of the esophagus, making swallowing difficult and/or painful.