In GERD, food, acid, and digestive juices flow back into the esophagus, the tube that connects the throat to the stomach. Over time, this causes irritation and swelling, known as esophagitis.
If you have acid exposure in the esophagus for even as little as a few weeks, you can develop inflammation of the lining. It can be very uncomfortable, even painful, and can leave the esophagus vulnerable to even more harmful erosion or scarring.Stomach acid can wear away the esophageal lining, causing sores or ulcers. (Esophageal ulcers are different than stomach ulcers, which are usually due to bacteria.) People with ulcers may spit up or vomit blood, or see it in stool. “It can be red or even darker, coffee-ground-like particulate.
If esophagitis goes on too long, scar tissue can narrow the esophagus. Called a stricture, this can make it hard or painful to swallow.
Large pieces of food can get stuck and may require endoscopy to remove them. You may also be at risk of choking, and you can lose too much weight if you avoid food and drinks because of a stricture. A stricture is treated with a dilation, or stretching, of the esophagus. This may need repeating, but acid-blocking meds such as proton pump inhibitors (PPIs) may prevent it from returning.
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.
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 to examine a sample of tissue. Many experts recommend endoscopy to check for Barrett’s esophagus in people who have risk factors, such as long standing heartburn (>10 years), white race, male gender and are overweight. 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 1 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, pantaprazoleand 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.