Complications for Acid
Reflux
Nearly everyone has an attack of heartburn
at some point in their lives. In the vast
majority of cases the condition is temporary
and mild causing only transient discomfort.
If patients develop persistent
gastroesophageal reflux disease with
frequent relapses, however, and it remains
untreated, serious complications may develop
over time. They can include the following:
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Erosive esophagitis (severe inflammation in the esophagus).
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Severe narrowing (stricture) of the esophagus.
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Barrett's esophagus.
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Problems in other areas, including the teeth, throat, and
airways leading to the lungs.
Older people are at higher risk for
complications from persistent GERD. The
following conditions also put individuals at
risk for recurrent and serious GERD:
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The esophagus is very inflamed.
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Initial symptoms are severe.
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Symptoms persist in spite of treatments that successfully heal
the esophagus.
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There are severe underlying muscular abnormalities.
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Erosive Esophagitis and its Complications
Erosive esophagitis develops in chronic
GERD patients when acid causes sufficient
irritation and inflammation to produce
extensive and injures the esophagus. Some
studies have suggested that overweight
Caucasian males with GERD are at
highest
risk for this condition. In anyone, however,
the longer and more severe the GERD
condition, the higher the risk for erosive
esophagitis.
Bleeding. In one study, bleeding occurred in over 8% of
patients with erosive esophagitis (severe inflammation of the
esophagus), which is associated with GERD. In very severe cases,
the patient may detect dark-colored, tarry stools (indicating
the presence of blood) or vomit blood, particularly if ulcers
have developed in the esophagus. This is a sign of severe damage
and requires immediate attention.
Sometimes long-term bleeding can result in iron deficiency
anemia and may sometimes even require emergency transfusions.
This condition can occur without heartburn or other warning
symptoms, or even obvious blood in the stools.
Barrett's Esophagus (BE) and Esophageal Cancer. In some
cases, BE develops as an advanced stage of erosive esophagitis.
BE results in abnormal cellular changes in the esophagus that,
in turn, puts a patient at risk for esophageal cancer. There are
many issues involved with BE, however, including its prevalence
and true severity that are unresolved.
Of note, GERD itself poses no significant
risk for esophageal cancer. One study
reported an annual incidence of 6.5 cancer
cases per 10,000 people with regular GERD
symptoms.
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Complications of Stricture
If the esophagus becomes severely
injured over time, narrowed regions called
strictures can develop, which may impair
swallowing (dysphagia). Food may even become
blocked in some cases. Stretching procedures
or surgery may be required to restore normal
swallowing. Paradoxically, strictures may
actually prevent other GERD symptoms by
helping to keep acid from traveling up the
esophagus.
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Asthma and Other Respiratory Disorders
Asthma. Asthma and GERD often occur
together. Studies report that reflux
disorder coincides with between 32% and 80%
of asthma cases. Some theories for the
causal connection between GERD and asthma
are as follows:
Acid leaking from the lower esophagus in GERD stimulates the
vagus nerves, which run through the gastrointestinal tract.
These stimulated nerves in turn trigger the nearby airways in
the lung to constrict, which causes asthma symptoms.
Acid back-up that reaches the mouth may be inhaled into
the airways (aspirated). Here, the acid triggers a reaction in the
airways that cause asthma symptoms.
There is some evidence that asthma causes
GERD. In contrast, some evidence suggests
that GERD causes asthma. Some clinical
trials report that treating GERD in patients
who also have asthma reduces symptoms of
both conditions. Not all such patients
report improved asthma symptoms with GERD
treatments, and they do not appear to have
much effect on actual lung function. One
study suggested that this approach works in
asthmatic individuals who tended to be
overweight and to have severe GERD in the
lower part of the esophagus.
Other Respiratory and Airway Conditions.
Current studies indicate an association
between GERD and various upper respiratory
problems that occur in the sinuses, ear and
nasal passages, and airways of the lung.
People with GERD appear to have an
above-average risk for chronic bronchitis,
chronic sinusitis, emphysema, pulmonary
fibrosis (lung scarring), and recurrent
pneumonia. If a person inhales fluid from
the esophagus (aspirates) into the lungs,
serious pneumonia can occur. It is not yet
known whether treatment of GERD would also
reduce the risk for these respiratory
conditions.
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Dental Problems
Dental erosion (the loss of the tooth's
enamel coating) is a very common problem
among GERD patients, including children. It
results from the acid backing up into the
mouth and eroding the enamel.
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Chronic Throat Conditions
An estimated 20% to 60% of patients with
GERD have atypical symptoms in the throat
(hoarseness, sore throat) without any
significant heartburn. A failure to diagnose
and treat GERD may lead to persistent throat
conditions such as chronic laryngitis,
hoarseness, difficulty in speaking, sore
throat, cough, constant throat clearing, and
granulomas (soft, pink bumps) on the vocal
cords.
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Sleep Apnea
GERD commonly occurs with obstructive
sleep apnea, a condition in which breathing
stops temporarily but repeatedly during
sleep. It is not clear which condition is
responsible for the other, but GERD is
particularly severe when both conditions
occur together. One study reported that
spasms in the vocal cords caused by acid
reflux may block the flow of air and cause
sleep apnea in adults. On the other hand,
other research suggests that the disordered
breathing in sleep apnea alters pressure in
the chest area and causes GERD. Both
conditions may also have risk factors in
common, such as sleeping on the back.
Studies suggest that in such patients GERD
can be markedly improved with CPAP, a device
that opens the airways and is the standard
treatment for severe sleep apnea.
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