What are the complications of gastroesophageal reflux disease?
Chronic reflux can lead to a number of serious problems, such as bleeding ulcers in the esophagus, and scarring leading to narrowing of the esophagus, (stricture). This results in difficulty swallowing solid foods. Chronic reflux may also be associated with Barrett's esohagus, a condition that may lead to cancer.
Some infants and children who have gastroesophageal reflux may not vomit, but may still have stomach contents move up the esophagus and spill over into the windpipe. This can cause asthma, pneumonia, and possibly even SIDS (sudden infant death syndrome). Infants and children with reflux who vomit frequently may not gain weight and grow normally.
Inflammation (esophagitis) or ulcers (sores) can form in the esophagus due to contact with stomach acid. These can be painful and also may bleed, leading to anemia (too few red blood cells in the bloodstream). Esophageal narrowing (stricture) and Barrett's esophagus (abnormal cells in the esophageal lining) are long-term complications from inflammation.
The liquid from the stomach that refluxes into the esophagus damages the cells lining the esophagus. The body responds in the way that it usually responds to damage, which is with inflammation (esophagitis). The purpose of inflammation is to neutralize the damaging agent and begin the process of healing. If the damage goes deeply into the esophagus, an ulcer forms. An ulcer is simply a break in the lining of the esophagus that occurs in an area of inflammation. Ulcers and the additional inflammation they provoke may erode into the esophageal blood vessels and give rise to bleeding into the esophagus. Occasionally, the bleeding is severe and may require transfusions of blood and endoscopic (a procedure in which a tube is inserted through the mouth into the esophagus) or surgical treatment.
Esophageal ulcers, which are open sores on the lining of the esophagus, can result from repeated reflux. They can cause pain that is usually located behind the breastbone or just below it, similar to the location of heartburn.
Narrowing (stricture) of the esophagus from reflux makes swallowing solid foods increasingly more difficult. Narrowing of the airways can cause shortness of breath and wheezing. Other symptoms of gastroesophageal reflux include chest pain, sore throat, hoarseness, excessive salivation (water brash), a sensation of a lump in the throat (globus sensation), and inflammation of the sinuses (sinusitis).
Long-standing and/or severe GERD causes changes in the cells that line the esophagus. These cells then become pre-cancerous, and finally cancerous. This condition is referred to as Barrett's esophagus, which occurs in approximately 10% of patients with GERD. The type of esophageal cancer associated with Barrett's esophagus (adenocarcinoma) is increasing in frequency.
Many nerves are in the lower esophagus. Some of these nerves are stimulated by the refluxed acid, and this stimulation results in pain (usually heartburn). Other nerves that are stimulated do not produce pain. Instead, they stimulate yet other nerves that provoke coughing. In this way, refluxed liquid can cause coughing without ever reaching the throat! In a similar manner, reflux into the lower esophagus can stimulate esophageal nerves that connect to and can stimulate nerves going to the lungs. These nerves to the lungs then can cause the smaller breathing tubes to narrow, resulting in an attack of asthma.
If refluxed liquid gets past the upper esophageal sphincter, it can enter the throat (pharynx) and even the voice box (larynx). The resulting inflammation can lead to a sore throat and hoarseness. As with coughing and asthma, it is not clear just how commonly GERD is responsible for otherwise unexplained inflammation of the throat and larynx. Refluxed liquid that passes the larynx can enter the lungs. The reflux of liquid into the lungs (called aspiration) often results in coughing and choking.