Gastroesophageal reflux disease (GERD) is costly. It affects nearly eight percent of American adults and costs the United States more than nine billion dollars each year in lost productivity. Sufferers spend an additional $13 billion on over-the-counter medications to combat their most common symptom: painful heartburn.
While most people experience occasional heartburn, GERD is a chronic condition that can occur daily. Left untreated, GERD causes serious complications over time.
When a person swallows, a complex set of muscles in the mouth and tongue close off the windpipe to protect the lungs and move the food into the esophagus (a narrow tube connecting the throat to the stomach).
At the bottom of the esophagus is a ring of muscles known as the lower esophageal sphincter (LES). A healthy LES encircles the food and pushes it into the stomach. However, the LES relaxes and allows stomach acid to enter the esophagus, causing a painful burning sensation in the middle abdomen in those with GERD.
While the stomach has a tough lining to resist the acid, the esophagus doesn’t. Therefore, sensitive tissue may be injured over time. Often, the acid will back up into the mouth, where it will damage other structures along the way.
Complications of GERD may include:
- Barrett's esophagus
- erosive esophagitis
- narrowing of the esophagus
- damage to the throat, teeth, and airways that lead to the lungs
Symptoms can be serious, especially in older people. They may include a severely inflamed esophagus, muscle abnormalities, or other symptoms that can’t improve with treatment.
A patient with Barrett's esophagus (BE) is at risk for esophageal cancer due to abnormal changes of cells in the esophagus. Approximately 10 percent of those with GERD will also have BE. However, around 50 percent of patients with BE will not exhibit any symptoms of GERD.
Obesity, smoking and alcohol use have all been identified as risk factors for BE. However, their role remains unclear. Those with both BE and symptoms of GERD are at a higher risk for the development of esophageal cancer.
Acid irritation and inflammation can injure the esophagus over time, creating a condition known as “erosive esophagitis.” Those who are obese (especially Caucasian males) are at the greatest risk for developing erosive esophagitis.
Approximately eight percent of those with the condition also experience bleeding, which can be seen in dark-colored stools or bloody vomit. Long-term bleeding indicates ulcers in the esophagus, which may result in iron-deficiency anemia. This is a serious condition that requires immediate attention.
The esophagus may become severely injured over time, resulting in narrowed areas known as “strictures.” Stricture may result in dysphagia (impaired swallowing). Occasionally, stricture may stop other symptoms of GERD by preventing acid from travelling up the esophagus.
Asthma and Other Respiratory and Throat Conditions
There is an undeniable connection between GERD and asthma, and the two conditions often appear together. Researchers believe that acid may back up into the esophagus, triggering changes to the immune system that lead to asthmatic conditions. In addition, acid that reaches the mouth may be inhaled and cause asthma.
Asthma may lead to GERD in some people as well, although the reasons why are still unclear. Those with GERD are at an increased risk for a host of other respiratory and throat conditions as well, including:
- chronic bronchitis
- chronic laryngitis
- chronic sinusitis
- difficulty speaking
- granulomas (pink bumps on the vocal cords)
- pneumonia (often recurring and serious)
- pulmonary fibrosis (lung scarring)
- sleep apnea
- constant throat clearing
Erosion of tooth enamel from acid backing up into the mouth is very common among those with GERD.
Reversing the Damages
Most people with GERD have mild symptoms that can be treated successfully by lifestyle changes such as: quitting smoking, losing weight, and eating smaller portions at meals. Foods to avoid include:
- citrus fruits
- colas and other carbonated beverages
- fried and fatty foods
- tomato sauce
In the majority of these cases, the body will heal itself and there won’t be long-term damage to the esophagus, throat, or teeth. More serious cases of GERD that result in the above conditions can often be treated with medications such as antacids, a coating agent (Carafate), H2-receptor blockers (Pepcid, Zantac), a motility agent (Reglan) or proton-pump inhibitors (PPIs, which are the most successful treatment for GERD).
Surgery proves a very effective treatment for GERD patients who don't respond to other treatments. Once GERD symptoms are under control, no further damage to the esophagus, throat, or teeth will occur.
While GERD can be a painful annoyance, it doesn’t affect longevity, and those who are able to resolve their symptoms will resume a normal, healthy and life.