Everybody has heartburn, right? The answer is probably yes, as most people experience heartburn, or acid reflux, at some time or other. The feeling is caused by a backwash of acidic stomach contents into the tube that carries your food from your mouth to your stomach (esophagus). It happens when the pressure in your stomach is elevated, there is a lot of food in your stomach, or when the band that keeps food in your stomach is weakened. Usually it passes with time, or with a change in diet or a mild antacid. However, if you are experiencing persistent reflux symptoms, it can be causing more serious problems than you think, and should not be ignored. There is a difference between experiencing simple reflux symptoms and having gastroesophogeal reflux disease (GERD), which can result in a number of complications. If you are having persistent problems, your acid reflux may be hurting you more than you know.
What is GERD?
Digestion begins in the mouth when you chew your food. After you swallow, the food travels through the esophagus, which has muscles that move in a rhythmic motion to push what you have eaten down into your stomach. At the end of the esophagus, where it connects to your stomach, there is a strong muscular ring called the lower esophageal sphincter (LES). This sphincter relaxes as the food empties into your stomach, and then tightens again so that food doesn’t come back into the esophagus. The LES performs a very important function in protecting the tissue in your esophagus. The stomach contains a lot of acid to help digest food before it moves on to your intestines, so the lining of the stomach has special properties to protect it from the acidic environment. However, the tissue of the esophagus is made differently, and can be damaged by stomach acids. If this occurs on occasion, the force of gravity and the act of swallowing saliva can help push the stomach contents back where they belong. However, if the LES is chronically weak, or if there is something causing the pressure in the stomach to rise on a regular basis, this constant insult to the tissue in the esophagus can cause damage that could be dangerous.
A number of things can cause recurrent reflux. If you have a hiatal hernia, which is when a part of the stomach slips through an opening in the muscle that separates the abdominal cavity from the chest (diaphragm), you would have higher pressures in the stomach, causing contents to be pushed back into the stomach. Other things that might cause higher pressures in the stomach are pregnancy, being overweight, and overeating. There are also things that can weaken the LES, including neurological disorders and some chemicals or drugs; for example, caffeine. This can be a very transient occurrence, say after you’ve eaten a big meal. The problem is, if it becomes a more persistent occurrence, eventually the tissue at the lower end of the esophagus will become inflamed and will have an even harder time keeping the stomach contents in the stomach, where they belong. Ultimately, scar tissue can form that will then create a narrowing in the esophagus. Taking all of this into consideration, reflux is not such a benign problem. Symptoms should not be ignored because esophageal damage, as well as other complications can arise.
Harmful Effects of GERD
As discussed earlier, persistent insult to esophageal tissue from reflux can result in inflammation. The constant exposure to an acidic environment can cause erosive esophagitis, resulting in ulcers in the esophagus, blood loss, and even tissue death. Additionally, the scar tissue that can result might cause narrowing of the esophagus, thus making it more difficult, or even painful to swallow. And chronic inflammation can create changes in the tissue itself. The newly formed tissue (Barrett’s epithelium) will, in fact, be more resistant to gastric acid. However, it is also considered precancerous and will require routine monitoring to make sure it does not progress to esophageal cancer.
The esophagus is not the only structure in the body that can be harmed from GERD. In reviewing anatomy, the esophagus goes from the stomach to the mouth. At the back of the throat there are other structures that do not do well in an acidic environment. The larynx, or voice box, can become inflamed, resulting in chronic laryngitis. If left untreated, this can progress to laryngeal cancer. Additionally, when you breath, air goes in the mouth and through the windpipe (trachea) to your lungs. The opening of the trachea is near the opening of the esophagus, thus chronic inflammation can cause a narrowing of the trachea resulting in shortness of breath, a chronic cough, wheezing or worsening of asthma, and even coughing up blood. Continuing to examine the nearby structures will reveal clues as to what other complications can arise. If your teeth are consistently exposed to acids, you can develop dental erosions. Because the sinuses and nasal structures are so close to the throat, you might have chronic sinusitis. If you consistently aspirate stomach contents, you could develop a chronic inflammatory disease of the lungs called pneumonitis.
In summary, everyone experiences some mild form of reflux from time to time, but chronic reflux is consistent with the diagnosis of GERD and should not go untreated. A good point to consider is that sometimes the severity of symptoms does not match the severity of the disease. In other words, you might have few symptoms and still have Barrett’s esophagus. Or, you might have frequent symptoms and have limited complications. The best way to determine what course of action you should take is to discuss it with your doctor if you are experiencing frequent symptoms of GERD, or any of the common signs associated with its complications. Simple treatments, in combination with lifestyle changes, can often control the harmful effects of the illness; and further testing can be performed if treatments do not help.
If you would like more information on GERD, are concerned that you might be experiencing frequent symptoms associated with reflux, or have any other concerns regarding your digestive health, we would be happy to help. At Austin Gastroenterology, your digestive health is our top priority. Call us at an office near you to set up an appointment: North Office (512) 244-2273, Central Office (512) 454-4588, and South Office (512) 448-4588. If you are an existing patient, you can request an appointment online.