GERD, Gastroesophageal Reflux Disease results from back flow of food and acid from the stomach to the Oesophagus. Any person will experience heartburn which is the principal symptom of GERD at some stage of their life which may be transient and mild. Patients with GERD will experience frequent and distressing symptoms unrelated to meals or posture.The condition results due to the weakness of the muscle at the junction between the oesophagus and the stomach what is also known as the “lower oesophageal sphincter”.
GERD is a condition which tends to have a long course may be lifetime of a patient. Symptoms can be well controlled with the existing medical therapy. A group of drugs called the proton pump inhibitors are the main category which is used to treat the condition. These drugs will dramatically reduce the acid secretion from the stomach.
Patients with long term GRED can have problems due to acid backflow into the oesophagus. The oesophagus is not an organ made to withstand long term acid reflux.
Long term effects of GERD include
- Oesophageal ulceration
- Stricturing of the oesophagus
- Barrett’s Oesophagus
- Oesophageal Cancer
- Decaying of teeth
Oesophagitis is the inflammation of the inner lining (Mucosa). Acid will damage the inner lining and will leads to an inflammatory response. Prolonged inflammation will lead to ulceration especially in the lower oesophagus. Patients with oesophagitis and ulcers will have worsening of heartburn and also painful swallowing (Odynophagia).
When ulceration occurs, the body attempts to heal by formation of new tissue. This might later leads to thickening of the oesophageal wall and with the contraction during healing there can be a narrowing of the oesophageal lumen. This is known as a stricture. Patients with strictures will experience difficulty in swallowing (Dysphagia) especially solid food. An endoscopic examination is urgently needed to exclude a sinister pathology in this situation.
Barrett’s oesophagus is a condition where the inner lining of the lower oesophagus will be replaced by the lining of the stomach. This process is call metaplasia of the epithelium. The main concern with this change is that it can progress to a cancer of the lower oesophagus. Barrett’s is diagnosed by the specific appearance of the mucosa of the lower oesophagus and confirmed by biopsy.
Patients with Barrett’s oesophagus need frequent endoscopic examinations and repeated biopsies to identify early changes of cancer. They will be treated with maximal acid suppression by medication.
Long term effects of GERD – Oesophageal Cancer
As described earlier Barrett’s oesophagus can gradually progress to an overt cancer of the oesophagus. Remarkably patients with Barret’s change experience less symptoms. The main symptom to suspect is when a patient complains of progressive difficulty in swallowing.
Other complications include bleeding form the ulcer leading to blood loss with the stools, which may give tarry stools (Malena)
Two extra oesophageal problems are also worth mentioning. Patients with GERD may present with wheezing due to reflux of acid to the respiratory passage. Sometimes this may be the initial presentation. Acid can also damage the enamel of the teeth leading to decaying of teeth.