What is GERD and what complications can arise from it?

What is GERD?

Gastroesophageal Reflux Disease, commonly known as GERD is a widely experienced disorder that is the result of a disordered valve mechanism between the esophagus (swallowing tube) and the stomach.

In the normal digestive process, the valve or lower esophageal sphincter (LES), opens during swallowing to allow food to enter the stomach and then closes to prevent food and stomach secretions from moving backward into the esophagus. With GERD, the LES fails to open and close correctly, and the stomach contents—which are acidic and contain digestive secretions—can flow back into the esophagus. This reverse flow (reflux) of food, acids and the digestive enzyme pepsin, can result in heartburn (and/or other symptoms) and potentially cause damage to the lower esophageal lining.

The symptoms include:

• Heartburn (burning in the central chest, behind the breastbone)
• Regurgitation (food rising up from the stomach into the back of the throat)
• Chronic cough
• Laryngitis
• Sore throat
• Asthma/Wheezing

Alarm symptoms:

There are alarm symptoms that you should watch out for that are not typical of GERD but could suggest additional, more severe health concerns. Talk to your doctor if you notice a change in your current symptoms or experience any of the following:

• Frequent heartburn not improving/responding to medications
• Difficulty swallowing or a feeling of trapped food in the esophagus
• Frequent nausea
• Vomiting, especially if it contains blood or bile
• Blood in the stools (tarry black or red)
• Unintentional weight loss
• Anemia

What’s the impact of chronic (long-lasting) GERD?

People who have severe, chronic GERD (daily heartburn over many years) can develop a condition called Barrett’s Esophagus. It is estimate that 15% of adult Canadians with GERD may develop it, so not everybody that has severe GERD will, but it’s important to understand if you are at risk.

Reflux of acid causes inflammation in the lower esophagus. As a result, the body tries to protect itself by changing the lining of the esophagus from its normal squamous lining (which is very sensitive to acid), to what’s called a columnar lining (which is not sensitive to acid). This protective action presents a problem because if you have normal squamous lining you will feel the acid, and therefore you will experience heartburn symptoms, but as the lining of the esophagus changes you are no longer sensitive to the acid. As such, a lot of people with Barrett’s Esophagus do not know they have it.

How do you know if you have Barrett’s Esophagus?

We do not fully understand the process of development of Barrett’s esophagus. However, there are risk factors for the development of Barrett’s esophagus that include:

• Male gender
• Those who have GERD for more than 5 years
• Over 50 years of age
• Caucasian
• Central obesity
• Smoking
• Family history

If you start to experience excessive or daily acid reflux, you should ask your doctor about GERD. Before treating GERD, you must first be diagnosed. Most of the time, symptoms alone can provide doctors with the information they need to make a diagnosis of GERD. If symptoms respond quickly to treatment, further investigation is usually not necessary. However, if symptoms are slow to improve or persistent, treatment is required, and diagnostic tests may be needed. Ask your doctor about considering a test such as an endoscopy to visualize if there is any damage to the lining of the esophagus from reflux.  

An endoscopy is a safe procedure that takes place in a hospital or a clinic, that involves passing a slim, flexible tube (endoscope) equipped with a light and tiny camera into the esophagus. The endoscope allows your doctor to examine the esophagus, where they can see if there is inflammation caused by acid reflux as well as Barrett’s esophagus. Your physician can also use the endoscope to look at the stomach and small intestine for irregularities. Learn more about the tests available here.

Further to this, there is evidence that a small proportion of those living with Barrett’s esophagus are at an increased risk of developing esophageal cancer. Early detection is key. If you or a loved one have chronic heartburn, don’t sleep on it! Talk to your doctor.