Heartburn is the most common symptom of gastroesophageal reflux disease (GERD). The cause of GERD is that the valve of the lower esophageal sphincter (LES) does not function properly. This valve is like a “gatekeeper” that keeps food and stomach acid from entering the esophagus. Once it functions abnormally, it allows acid to flow back into the esophagus, causing chronic damage and inflammation.
You may be able to grit your teeth and try to tolerate the discomfort from heartburn. But if left untreated, it can lead to serious long-term side effects.
Heartburn may be associated with the following diseases
Esophagitis, Barrett’s esophagus, and esophageal cancer
A report published in the American Journal of Clinical Oncology (AJCO) noted a dramatic increase in the incidence of esophageal adenocarcinoma, which may be associated with an increased incidence of GERD.
The report says that the incidence of esophageal adenocarcinoma has increased sixfold over the past few decades and that more than 80% of patients die within 5 years. The researchers found that the main risk factors for esophageal adenocarcinoma are gastroesophageal reflux disease and its associated conditions (such as Barrett’s esophagus). Barrett’s esophagus (BE) is a precancerous lesion of esophageal cancer.
Other associated risk factors include, smoking, heavy alcohol consumption, obesity, and a diet low in fruits and vegetables.
Why is GERD so closely related to esophageal cancer?
This is because repeated reflux of stomach acid into the esophagus can damage the lining layer, leading to inflammation and inducing painful sensations. The constant damage to the esophagus by stomach acid can lead to bleeding.
If the bleeding is severe enough, blood can enter the digestive tract and you may pass black or tarry stools.
Esophagitis that does not heal over time can also cause ulcers, which can be painful open wounds on the inner surface of the esophagus.
Harm of GERD
If GERD is not treated aggressively, the esophagus is “immersed” in acid for a long time, turning the normal “squamous epithelium” of the inner mucosa into “columnar epithelium,” which replaces the damage caused by GERD. These cells replace the cells damaged by acid reflux, thus inducing Barrett’s esophagus. These abnormal cells have the potential to become cancerous.
Patients with Barrett’s esophagus are at increased risk for adenocarcinoma, which is more common in white men over age 50 who smoke or are obese. If you have chronic, severe manifestations of heartburn, you should seek medical attention.
Esophageal stricture
Over time, esophageal injury can produce scarring that causes narrowing of the esophagus, causing difficulty swallowing, interfering with food and water intake, and even causing esophageal spasms and chest pain similar to a heart attack.
Patients with esophageal constriction may find some relief from heartburn symptoms because the constricted segment blocks stomach acid from moving up into the esophagus. However, please note that this does not mean that the disease is in remission.
Asthma and other respiratory problems
Asthma and heartburn often occur together. Studies have found that about 30-80% of people with asthma experience symptoms of GERD. However, asthma and GERD, who is the cause and who is the effect, scientists have not yet found an answer. One possible explanation is that acid refluxing upward in the stomach into the airways causes asthma.
GERD is also associated with other respiratory diseases, such as
- Chronic bronchitis
- Chronic cough
- Chronic sinusitis
- emphysema
- Pulmonary fibrosis (scarring of the lungs)
- Recurrent pneumonia
- Voice and throat problems
GERD refluxed stomach acid can affect the throat, causing hoarseness and laryngitis. Some people with very severe acid reflux can experience voice changes. However, with treatment for GERD, your voice and throat problems will gradually improve.
Dental problems from reflux
Corrosive stomach acid can sometimes enter the mouth and cause serious damage to tooth enamel. Numerous studies have found that people with GERD are more likely to have tooth erosion, which can also cause bad breath and increased saliva production.
Complications of heartburn in children
Infants and children can also experience heartburn and other symptoms of GERD. They may not be able to express exactly how uncomfortable they feel, but if left untreated, they can develop many of the same complications as adults.
Infants with severe acid reflux are not fed properly and often have poor development. If the infant breathes acid into the airway, it can also cause recurrent pneumonia.
Sudden infant death syndrome may be associated with airway obstruction due to reflux, according to some studies.
How can I avoid complications of reflux and improve heartburn symptoms?
First, a gastroenterologist will use a gastrointestinal endoscope to examine your esophagus to determine if there is a problem such as Barrett’s esophagus (BE). Imaging tests such as upper gastrointestinal angiography and CT can also assist your doctor in making a determination.
If a diagnosis of GERD is made and you need to receive medication and lifestyle interventions, follow your doctor’s instructions and treat it aggressively. In rare cases, surgery is needed to reduce esophageal blockage and prevent upward reflux of stomach acid.
For more information, please read the following articles:
- The basics of heartburn and GERD