What Is Acid Reflux (GERD)? Understanding the Causes, Symptoms, and Risks
What Is Acid Reflux (GERD)?
Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common digestive disorder involving the lower esophageal sphincter located between the stomach and the esophagus. This sphincter functions as a gate: during normal digestion, it opens briefly to allow food to pass into the stomach, then closes to prevent the contents from flowing back into the esophagus. However, when the sphincter fails to close properly, stomach acid and partially digested food can flow back into the esophagus. Because the esophageal lining lacks the protective mucosa found in the stomach, this exposure can cause damage and lead to ulceration. Typical symptoms of acid reflux include a burning sensation in the chest (commonly known as heartburn), throat inflammation, and difficulty swallowing. If the condition persists, it may progress to Barrett’s esophagus, which increases the risk of esophageal adenocarcinoma.
Causes of Acid Reflux
Acid reflux can result from a variety of factors, including poor diet, unhealthy lifestyle habits, and underlying medical conditions. The most common causes are outlined below.
Poor Dietary Habits
Frequent overeating, oily meals, smoking, alcohol consumption, and caffeinated beverages such as coffee and tea can all cause the lower esophageal sphincter to relax. Excessive intake of irritants such as spicy or fried foods may further weaken sphincter function. In addition, consuming large amounts of acidic beverages, including carbonated drinks and coffee, can increase the likelihood of acid reflux.
Obesity
Being overweight or obese places additional pressure on the abdomen and can cause the lower esophageal sphincter to relax, raising the risk of acid reflux.
Hiatal Hernia
The diaphragm contains an opening called the hiatus, through which the esophagus connects to the stomach. A hiatal hernia occurs when the upper portion of the stomach pushes through this opening into the chest cavity. This is often caused by weakening of the diaphragmatic muscles surrounding the hiatus or by excessive abdominal pressure, both of which can compromise the gate function of the hiatus and allow the stomach or other abdominal organs to protrude into the chest. Once the hiatus loses its sealing function, acid reflux may occur.
The exact cause of hiatal hernia remains unclear, but known risk factors include:
- A congenitally enlarged hiatus
- Excess abdominal fat tissue causing prolonged high abdominal pressure, such as in obese individuals
- Degeneration of the diaphragmatic muscles
- Frequent overeating or eating too quickly
- Chronic bronchitis
- Age 50 or above
Common Symptoms of Acid Reflux
Acid reflux can affect the esophagus, throat, and mouth, with symptoms typically more pronounced after meals and during sleep. Common symptoms include:
- A burning sensation in the chest, often described as a fiery feeling
- Pressure or discomfort in the upper abdomen, accompanied by frequent belching
- Persistent coughing
- A choking sensation
- Hoarseness
- Bad breath
- A bitter taste in the mouth
What Is Barrett’s Esophagus?
If acid reflux persists over a prolonged period, it may progress to Barrett’s esophagus, a precancerous condition that significantly increases the risk of esophageal cancer. Esophageal cancer is generally classified into two types: squamous cell carcinoma and adenocarcinoma. The latter is most commonly seen in patients with Barrett’s esophagus, as repeated acid exposure can cause ulceration in the lower esophagus and damage the mucosal lining, eventually leading to cellular changes. Individuals who have experienced prolonged acid reflux without seeking medical attention, as well as those with related complications, are considered high risk for developing Barrett’s esophagus. Common symptoms include:
- Frequent burning chest pain and upper abdominal discomfort
- Acid reflux
- Difficulty swallowing
- Esophageal ulcers
- Blood in vomit
The Relationship Between Acid Reflux and Barrett’s Esophagus
Chronic acid reflux can cause structural changes in the lower portion of the esophagus. Under repeated exposure to stomach acid, the esophageal mucosa may undergo a process known as metaplasia, in which it gradually transforms into glandular mucosa typically found in the intestines. This change marks the onset of Barrett’s esophagus. Once the esophageal mucosa has been replaced by intestinal mucosa, the cells may continue to deteriorate and eventually become cancerous. The progression from acid reflux to Barrett’s esophagus, and ultimately to cancer, generally takes several years and can sometimes span 8 to 10 years. For this reason, regular health screenings are essential to the prevention of esophageal cancer.
Cancer Risk Associated with Barrett’s Esophagus
All cases of Barrett’s esophagus carry some potential to progress to cancer, with an annual risk of 0.2% to 0.7% per patient. When evaluating this risk, two key factors are typically considered: the extent of esophageal lesions and the degree of dysplasia.
Extent of Esophageal Lesions
When the affected area of the esophagus exceeds 3 centimeters, the likelihood of cancerous transformation is generally higher.
Degree of Dysplasia
Dysplasia refers to abnormal cell growth in the esophagus in which precancerous cells have not yet invaded the deeper layers of the mucosa. Diagnosis typically requires an endoscopy with tissue biopsy to confirm whether dysplasia is present. Dysplasia is broadly classified into two categories: low grade and high grade. As severity increases, so does the likelihood of progression to esophageal cancer. The risk is approximately 10 to 15% for low grade dysplasia and around 25% for high grade dysplasia.
FAQs About Acid Reflux and Barrett’s Esophagus
1. Does acid reflux (GERD) carry a risk of developing into cancer?
If the esophageal mucosa is repeatedly damaged by acid reflux and undergoes metaplasia, transforming into the glandular mucosa typically found in the intestines, it may lead to Barrett’s esophagus and increase the risk of esophageal cancer.
2. How is Barrett’s esophagus diagnosed, and what follow up examinations and treatments are recommended?
Patients experiencing suspected symptoms should consult a family physician or gastroenterologist, who will determine whether an endoscopy is needed. During the procedure, the doctor examines the esophagus to assess the severity of acid reflux and check for any abnormal mucosa. To confirm a diagnosis of Barrett’s esophagus, a tissue biopsy is performed to verify mucosal changes and the presence of dysplasia.
If Barrett’s esophagus is confirmed, follow up examinations are recommended every 2 to 3 years for ongoing monitoring. If dysplasia is detected, more frequent examinations and prompt treatment are advised. Treatment typically involves the use of an endoscope to remove the affected mucosa, followed by cryotherapy or radiofrequency ablation (RFA).
3. What dietary and lifestyle precautions should patients with acid reflux or Barrett’s esophagus take?
For patients with mild acid reflux symptoms or early stage Barrett’s esophagus, a doctor may recommend managing the condition through dietary and lifestyle adjustments. However, if symptoms persist or worsen, medication may be required. The most common treatment involves proton pump inhibitors (PPIs), which reduce stomach acid production.
| Recommended | Avoid | |
|---|---|---|
| Diet | ‧ Beverages: Chamomile tea, aloe vera juice, ginger water, ginger tea ‧ Foods: Red apples, pears, bananas, peaches, lettuce, celery, egg whites, yogurt, red rice, tofu ‧ Unsaturated fats: Olive oil, seed oils | ‧ Beverages: Alcohol, tea, black tea, coffee ‧ Foods: Dairy products, tomatoes, tomato sauce, onions, garlic, chocolate, pomelo, grapefruit |
| Lifestyle | ‧ Exercise regularly ‧ Reduce portion sizes | ‧ Lying down immediately after meals ‧ Eating large meals 2 to 3 hours before sleep |
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