Gastroesophageal Reflux Disease (GERD) is a chronic condition where stomach contents persistently flow back into the esophagus. This occurs when the lower esophageal sphincter, the muscle connecting the esophagus and stomach, weakens or relaxes inappropriately, allowing caustic digestive fluids to ascend. While occasional heartburn is common, chronic GERD causes serious, progressive tissue damage. Understanding the negative outcomes of untreated GERD is essential for informed medical management.
Acute Tissue Damage
The initial consequence of repeated acid exposure is inflammation of the esophageal lining, known as esophagitis. The esophagus’s delicate protective layer is not built to withstand highly acidic gastric juice. Persistent chemical irritation causes the mucosa to become irritated and swollen, leading to heartburn and chest discomfort.
Continued tissue damage can erode the lining, resulting in open sores called esophageal ulcers. Ulcers cause pain upon swallowing (odynophagia) and may lead to bleeding. Chronic, slow bleeding can cause iron deficiency anemia, while severe cases may present as bloody vomit or dark, tarry stools.
Chronic Scarring and Narrowing
If esophagitis persists without effective management, the body’s repair mechanisms lay down scar tissue (fibrosis). This chronic injury and healing response leads to structural changes in the esophageal wall. Since scar tissue is less flexible than the normal lining, the esophagus progressively narrows.
This complication is known as an esophageal stricture, which physically impedes the passage of food and liquids. The primary symptom is dysphagia, or difficulty swallowing, where solid foods feel stuck in the chest. Worsening narrowing may cause individuals to change eating habits, leading to unintentional weight loss. Approximately 80% of esophageal strictures are attributed to long-standing, unmanaged GERD.
Cellular Changes and Cancer Risk
The most significant long-term risk of untreated GERD involves fundamental cellular changes in the lower esophagus. Prolonged exposure to acid and bile triggers metaplasia, where normal squamous cells are replaced by tissue resembling the intestinal lining. This specific change is defined as Barrett’s Esophagus and is considered a premalignant condition.
Barrett’s Esophagus develops in 10% to 15% of individuals with chronic GERD, typically after a decade of persistent reflux. Although the annual risk of progression to cancer is small, Barrett’s requires regular endoscopic surveillance. Surveillance monitors for increasing cellular abnormality, termed dysplasia, which is categorized as low-grade or high-grade and is a direct precursor to malignancy.
The most severe outcome is the development of Esophageal Adenocarcinoma (EAC). This cancer is strongly linked to the progression of Barrett’s Esophagus, arising from the glandular cells in the metaplastic tissue. Once EAC is diagnosed, the prognosis is often poor. Early intervention and adherence to surveillance protocols for Barrett’s Esophagus are paramount for managing this disease.
Effects Beyond the Esophagus
The impact of chronic reflux is not confined solely to the esophagus; acid and enzymes can extend into other areas, causing complications outside the digestive tract. When stomach contents are regurgitated high enough, droplets can be aspirated into the airways, leading to respiratory issues. This microaspiration can manifest as a persistent cough or exacerbate pre-existing conditions like asthma.
Reflux reaching the vocal cords and larynx causes irritation and inflammation, known as laryngitis. Symptoms include a hoarse voice, a frequent need to clear the throat, and a sensation of a lump in the throat. Additionally, acid entering the mouth causes significant damage to the teeth. The highly acidic content wears down protective tooth enamel, leading to dental erosion, which affects up to 24% of adults with GERD.