There exists a perception that acid reflux is at most an annoying, trivial problem that’s treatable with over-the-counter medications. But in reality, untreated or insufficiently treated acid reflux disease brings on a progressively severe series of ailments beginning with inflammation of the esophagus, leading to esophageal ulcers and then regions of scarring and narrowing in the esophagus known as strictures. When acid reflux continues unabated, a condition called Barrett’s esophagus can develop, which may progress to esophageal cancer. While this may sound ominous, the good news is that most potential complications of acid reflux disease are not only treatable, but also preventable.
Esophagitis and Esophageal Ulcers
The most common complication of acid reflux disease is inflammation of the esophagus, known as esophagitis. Stomach acid causes injury to cells that line the esophagus, leading to pain felt as heartburn. This is not only distressing in itself, but one should think of esophagitis as a launching pad for progressively more serious conditions.
As acid-mediated injury continues in the esophagus, the lining begins to break down and ulcers form. Ulcers are severely inflamed open sores that look like craters. If esophageal ulcers are not treated, they can bleed, occasionally profusely, so treatment is strongly advised.
Another complication of acid injury in the esophagus is scarring, with the subsequent development of narrowed areas known as strictures. The esophagus is normally a supple organ that expands and contracts to accommodate varying amounts of solid and liquid food. As its pliable cells become replaced by scar tissue, the esophagus becomes stiff and narrowed. When severe, food will become stuck in the esophagus, making it progressively more difficult to swallow. Just like a clogged shower drainpipe, when one has an esophageal stricture, food can back up above the area of stricture and end up back in the throat and mouth. Usually the symptoms caused by strictures develop gradually, starting with the insidious onset of foods occasionally getting stuck in the chest.
Beyond the benign nature of continued acid-induced inflammation of the esophagus lies a world of potentially precancerous and cancerous conditions. With persistent reflux injury, the cells normally lining the lower part of the esophagus can start to be replaced by cells resembling those that typically line the stomach. The presence of stomach-like cells in the esophagus is referred to as Barrett’s esophagus.
Approximately 5 to 15 percent of people who undergo endoscopy for acid reflux disease are found to have Barrett’s esophagus, according to an article published in The Lancet in March 2009. Men typically develop Barrett’s esophagus twice as often as women, and it is most common in white males over the age of 50. People with Barrett’s esophagus are much more likely to develop esophageal adenocarcinoma than those without the condition. According to an article published in the June 2015 issue of Gastroenterology Clinics of North America, every year approximately one in every 750 people with Barrett’s esophagus will be newly diagnosed with esophageal cancer.
The most devastating complication of acid reflux disease is esophageal cancer, specifically esophageal adenocarcinoma. According to an article in the June 2013 issue of Cancer, the incidence of esophageal adenocarcinoma has grown an unprecedented 650 percent since 1975, making it the fastest growing cancer in America and Europe. While several other malignancies, such as lung, breast, prostate and colon cancer, are more common, esophageal cancer is typically not diagnosed until a relatively late stage when it is less able to be treated successfully.
Complications of Laryngopharyngeal Reflux Disease
There are several potential complications of LPRD. People with untreated or insufficiently treated LPRD have an increased likelihood of developing asthma; stenosis (narrowing) of the vocal cords; benign tumors of the vocal cords called granulomas; or cancer of the larynx (the voice box) or pharynx (the throat). It is important to note that although LPRD is considered a risk factor for these conditions, no studies have proven that LPRD directly causes them.
Because of the possibility of serious complications from acid reflux disease, it is important to seek medical attention if you have symptoms suggesting any problems in the esophagus, including heartburn, regurgitation or the sensation of food getting stuck in your chest area. You should also see your doctor if you have symptoms that might be due to LPRD, such as a chronic cough for more than eight weeks, hoarseness, frequent throat-clearing or a lump-like sensation in the throat.
- Journal of the National Cancer Institute: The Role of Over-Diagnosis and Reclassification in the Marked Increase of Esopha¬geal Adenocarcinoma Incidence.
- The New England Journal of Medicine: Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma.
- World Journal of Gastroenterology: From Reflux Esophagitis to Barrett’s Esophagus and Esophageal Adenocarcinoma.
- Gastroenterology: Control of Gastric Acid Secretion in Health and Disease.
- Diseases of the Esophagus: Evaluation and Management of Benign Esophageal Strictures.
- Alimentary Pharmacology and Therapeutics: Meta Analysis - Cancer Risk in Barrett's Oesophagus.
- American Journal of Epidemiology: The Incidence of Esophageal Cancer and High-Grade Dysplasia in Barrett’s Esophagus
- Annals of Oncology: The Incidence of Esophageal Adenocarcinoma Continues to Rise
- Gastroenterology Clinics of North America: Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma.
- Digestive Diseases and Sciences: Yield of Repeat Endoscopy in Barrett's Esophagus with No Dysplasia and Low-Grade Dysplasia