Complications of gastroesophageal reflux in adults
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
Gastroesophageal reflux disease (GERD) may result in esophageal or extraesophageal complications. These complications may result from direct inflammation due to the refluxate or as a consequence of the reparative process (eg, peptic stricture and Barrett's metaplasia). This topic will review the complications of GERD. The pathophysiology, clinical manifestations, diagnosis, and management of GERD are discussed separately. (See "Clinical manifestations and diagnosis of gastroesophageal reflux in adults".)
Erosive esophagitis — Erosive esophagitis occurs when excessive reflux of acid and pepsin results in necrosis of surface layers of esophageal mucosa, causing erosions and ulcers. Patients with erosive esophagitis can be asymptomatic or present with heartburn, regurgitation, dysphagia, and odynophagia . The diagnosis and management of erosive esophagitis are discussed separately. (See "Clinical manifestations and diagnosis of gastroesophageal reflux in adults", section on 'Esophagitis on esophagoscopy' and "Medical management of gastroesophageal reflux disease in adults", section on 'Severe or frequent symptoms or erosive esophagitis'.)
Barrett's esophagus — Barrett's esophagus is a condition in which metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus. The metaplastic epithelium is acquired as a consequence of chronic gastroesophageal reflux disease (GERD) and predisposes to the development of esophageal cancer. The specialized intestinal columnar metaplasia typical of Barrett's esophagus causes no symptoms. Most patients are seen initially for symptoms of associated GERD, such as heartburn, regurgitation, and dysphagia. GERD associated with long-segment Barrett's esophagus is frequently complicated by esophageal ulceration, stricture, and hemorrhage. (See "Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis", section on 'Clinical features'.)
Esophageal stricture — Peptic strictures are a result of the healing process of ulcerative esophagitis. Collagen is deposited during this phase and, with time, the collagen fibers contract, narrowing the esophageal lumen. These strictures are usually short in length and contiguous with the gastroesophageal junction; endoscopy may also reveal adjacent areas of reflux esophagitis (picture 1 and image 1). Patients may have solid food dysphagia and episodic food impaction. The management of benign esophageal strictures involves dilation combined with acid-suppressive therapy with a proton pump inhibitor to prevent the recurrence of strictures once they have been adequately dilated [2-5]. (See "Management of benign esophageal strictures" and "Medical management of gastroesophageal reflux disease in adults".)
Regurgitation and/or aspiration of gastric juice have been associated with several extraesophageal complications. However, the role of gastroesophageal reflux disease (GERD) in the pathogenesis of these disorders is often overestimated.
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