Gastroesophageal reflux disease (GERD) is a condition where stomach acid rises back up into the esophagus.
Most commonly, the refluxed gastric (stomach) contents are acidic, but bile (non-acidic fluid) may also be present in the gastric juice. GERD is a common problem in the United States, where the symptom of heartburn, at least once a week, is present in 20 percent of the population. In addition, GERD accounts for 75 percent of overall esophageal diseases in the United States.
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GERD is a serious problem and patients with severe GERD have a quality of life similar to patients with angina or heart failure. Further, complications of GERD such as Barrett’s esophagus and peptic stricture can occur in 50 percent of patients, and other esophageal and gastric abnormalities, such as a paraesophageal hernia are commonly associated with the disease.
The severity of the complications of GERD is directly related to the presence of a mechanically defective lower esophageal sphincter (malfunctioning of the valve between the esophagus and the stomach) and presence of both acid and bile in the esophagus.
Combined reflux of gastric acid and bile into the esophagus causes severe damage to its lining. This can result in changes in the esophagus called Barrett’s esophagus, which can be transformed to dysplasia (abnormal cells in the esophagus) and esophageal adenocarcinoma (cancer).
Patients with recurring symptoms of reflux have an eightfold increase in the risk of esophageal adenocarcinoma. Therefore, we believe that GERD is a serious health problem and anyone with more than the occasional episode of heartburn or regurgitation, and in particular anyone with dysphagia (difficulty swallowing) should be evaluated with an upper endoscopy.
By Farzaneh Banki, M.D.
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