Gastroesophageal reflux disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

If left untreated, 20% of patients with GERD may progress to develop esophageal stricture due to excessive acid in the lower esophagus. Complications of GERD include barrett's esophagus, erosive esophagitis, esophageal ulcer, and esophageal adenocarcinoma. Prognosis of GERD is good with the appropriate treatment.

Natural History, Complications and Prognosis

Natural History

• The symptoms of GERD include heart burn, regurgitation, and dysphagia.
• If left untreated, GERD will develop to esophageal stricture which occurs in around 20% of the patients with GERD.
• Esophageal stricture occur due to excessive acid in the lower of the esophagus which lead to scar formation. This scar causes narrowing of the esophagus and lead to difficulties in swallowing.

Complication

Complications that can develop as a result of GERD include the following:

• Barrett's esophagus:
  • A type of dysplasia, is a precursor high-grade dysplasia, which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated to include 0.1% to 0.5% of cases, and has probably been exaggerated in the past.
  • Due to the risk of chronic heart burn progressing to Barrett's esophagus, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.
• Erosive esophagitis
• Esophageal ulcer:
  • The excess acid secretion in the esophagus can lead to ulcer formation which increases pain in GERD patients.
• Esophageal adenocarcinoma

Prognosis

• The majority of people respond to nonsurgical measures, with lifestyle changes and medications. However, many patients need to continue to take drugs to control their symptoms.