Complications Of Reflux - Gastroesophageal Reflux Disease: Digestive Disorders
Content provided by the Faculty of the Harvard Medical School
Complications of reflux
Though simple reflux is uncomfortable, it doesn't usually pose a danger to healthy individuals. From half to three-quarters of those with reflux disease have mild symptoms that generally clear up in response to simple measures. Over time, however, serious problems can develop when persistent GERD with frequent relapses goes untreated. These complications can include severe narrowing (stricture) of the esophagus, erosion of its lining, precancerous changes in its cells, and esophageal ulcers.
One complication, known as reflux esophagitis, is inflammation that occurs when acid and pepsin, released from the stomach, erode areas of the mucosa, the surface layer of cells that line the esophagus. Besides the burning sensation of heartburn, patients with esophagitis may also complain of pain behind the breastbone spreading into the back or up to the neck, jaw, or even the ears. The pain can be so intense that you may have trouble swallowing and may even think you are having a heart attack.
With esophagitis, food may feel as if it sticks in your throat before going down the gullet. Hot drinks are unpleasant to swallow, and you may have some nausea. You may also regurgitate some acid fluid into your throat, resulting in a cough. The inflammation of the esophagus can even lead to bleeding. Endoscopy is necessary to confirm the diagnosis of esophagitis and locate any associated ulcers or strictures.
Is this test necessary?Doctors ordinarily don't put heartburn patients through costly diagnostic evaluations. However, more serious reflux symptoms, such as bleeding from the esophagus, swallowing problems, or severe symptoms that fail to respond to standard treatment for GERD, may warrant further investigation. Common tests include the following: Barium studies. The patient drinks a liquid barium mixture and then undergoes an x-ray examination of the chest and upper abdomen. The barium, a contrast medium, defines the upper GI tract on the x-ray image and can help the physician identify problems such as a hiatal hernia, esophageal ulcers, or a stricture (narrowing) of the esophagus. This test is also called an upper GI series. Upper GI endoscopy. The physician inserts a flexible tube down the throat, having first sedated the patient and depressed the gag reflex with a local anesthetic spray. The tube contains a light and camera, which allow the doctor to inspect the lining of the esophagus, assess injuries such as ulcers or strictures, and take a biopsy (a tissue sample), if necessary. Trans-nasal esophagoscopy. This diagnostic imaging technique employs a scope that is smaller than a standard endoscope. The scope is inserted through the nose (rather than the mouth) and into the esophagus. No sedation is needed, and patients can see the images and learn the results immediately. This test is not yet widely available, but may become more useful for screening patients with GERD for Barrett's esophagus (see "Complications of reflux") right in the doctor's office. pH monitoring. Used less frequently, this test monitors an individual's reflux episodes over 24 hours via a thin, acid-sensing probe inserted through the nose and positioned just above the LES. Although moderately expensive and somewhat uncomfortable, this is the best method for documenting reflux in patients who have unexplained chest pain, coughing, wheezing, or hoarseness. It's also used to assess the adequacy of acid-suppressing therapy when symptoms persist. If the medication doesn't relieve your symptoms, the cause of your discomfort may be something other than reflux. Impedance testing. This test, approved in the United States in 2002 and available in a growing number of specialized centers, can be done at the same time as pH monitoring. Probes equipped for this test include a pair of metallic rings that measure changes in electrical resistance that occur as food and gas pass through the digestive system. It can detect both non-acid as well as acid reflux and may thus explain symptoms that persist despite adequate acid suppression therapy. |
Bleeding ulcers in an inflamed esophagus may require aggressive treatment, such as blood transfusions and, to stop the bleeding, a probe passed through an endoscopic tube to apply electricity or heat to the bleeding site. Strictures may need to be dilated through endoscopy, using a balloon or special dilator. About one-third of patients who need this procedure require a series of treatments to fully open the passageway.
Another complication of chronic esophageal inflammation is Barrett's esophagus, an abnormality in which taller cells resembling those that line the small intestine replace the squamous or flat cells that normally line the lower esophagus. The condition, a potential consequence of longstanding GERD, is caused by long-term and severe exposure to acid from the stomach and bile from the small intestine. Barrett's esophagus can, over time, develop into cancer, so patients are urged to have regular endoscopic evaluations (including biopsies) to identify very early malignant changes. Persons most at risk are those — usually middle-aged white men — who developed GERD at an early age and have had it for many years.
An important study published in 1999 reported a higher risk for esophageal cancer in GERD patients, whether or not they have Barrett's esophagus. Fortunately, only a very small percentage of patients with GERD will develop esophageal cancer. Some experts think it's the reflux of bile, in addition to acid, that heightens the risk for esophageal cancer.
GERD can also result in dental problems, including loss of tooth enamel. And it can cause spasms of the vocal cords (larynx), blocking the flow of air to the lungs. One study has reported that such spasms may cause sleep apnea, a condition in which breathing frequently stops for brief moments during sleep.
| Last updated: | August 21, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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