Heartburn refers to the feeling of acid reflux within the esophagus.
The vast majority of people will experience heartburn at a certain point in their lives.
However, a considerable portion will progress to chronic disease, which is known as gastrointestinal reflux disease (GERD).
Despite how benign heartburn may seem, it could lead to some serious complications when left untreated. Unfortunately, many people ignore heartburn or rely on some quick fixes, such as antacids, to relieve their symptoms.
In this article, we will cover the most serious complications that occur when you don’t treat heartburn. We will also touch on a revolutionary new drug that addresses the underlying cause instead of the presenting symptoms.
The most fearsome complication of untreated heartburn
Decades of untreated acid reflux and heartburn is called Barrett’s esophagus. It occurs when the cells lining the esophagus undergo a transformation to cells found in the intestines rather than the usual esophageal cells. To simplify, if you examine a segment of Barrett’s esophagus, you’ll discover cells more typical of the intestines. Doctors refer to this phenomenon as metaplasia. This transformation is a result of prolonged exposure to stomach acid. Normally, the lower esophageal sphincter (LES) prevents contact between the food pipe and the stomach. However, if this sphincter becomes loose, the sensitive esophageal cells are exposed to the stomach’s low pH. In response to the body’s tendency to maintain balance (homeostasis), the esophageal cells adapt to endure this challenging environment. Unfortunately, untreated Barrett’s esophagus can progress to esophageal cancer. Therefore, monitoring and appropriate medical interventions are indispensable to manage and mitigate these risks.What causes Barrett’s esophagus?
Scientists have yet to pinpoint the exact cause of Barrett’s esophagus, but it’s closely linked to GERD. When the muscles in the lower esophageal sphincter relax, stomach contents can flow back into the esophagus. Although some develop Barrett’s esophagus without chronic heartburn, those with acid reflux are five times more likely to develop it. Reports indicate 5%–13% of chronic heartburn patients will develop Barrett’s esophagus. A higher incidence is seen in men over the age of 55 years old. Consequently, Barrett’s esophagus doesn’t necessarily progress to cancer but increases its risk. The best way to mitigate this risk is by treating heartburn early on in the process.What are the risk factors?
Aside from chronic heartburn, other risk factors of Barrett’s esophagus include:- Gender – Men tend to be at a higher risk.
- Race (e.g., Caucasians).
- Advanced age.
- A history of gastritis caused by H. pylori.
- Being overweight or obese.
- Smoking.
Some factors that worsen heartburn can also exacerbate Barrett’s esophagus. These include
- Smoking.
- Alcohol.
- Ibuprofen and other over-the-counter anti-inflammatory drugs.
- Copious meals.
- Meals rich in saturated fats.
- Spicy foods.
The signs and symptoms of Barrett’s esophagus
Barrett’s esophagus typically does not present with any specific signs. As most patients also have heartburn, they commonly experience acid reflux symptoms. If you notice any unusual symptoms, make sure to contact your doctor for further evaluation.Some symptoms that suggest Barret’s esophagus include:
- Severe chest pain.
- Vomiting blood.
- Difficulty swallowing.
- Black or tarry stools.
The diagnosis of Barrett’s esophagus
Most cases of Barrett’s esophagus are found in people around 55 years old. When you tell your doctor about heartburn symptoms, they’ll ask about your medical history, perform a physical examination, and order an endoscopy. In this procedure, a small tube with a camera and light is inserted into your esophagus. The doctor uses it to look for any unusual tissue changes. If Barrett’s esophagus is suspected, the doctor may take a tiny piece of tissue for examination. A pathologist looks at it under a microscope to find any abnormalities.After the first endoscopy, follow-ups are scheduled like this:
- If no changes are found, repeat every 3 years.
- If there are mild changes, another procedure is done in 6–12 months.