Heartburn the Esophagus and GERD

Heartburn the Esophagus and GERD

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Nearly half of Americans have heartburn at least once a month.

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The interior of your stomach is, of necessity, an acidic, hostile environment. The hydrochloric acid secreted by your stomach lining extracts nutrients from food, activates digestive enzymes and protects you from pathogenic organisms. However, while your stomach has built-in mechanisms for protecting it from acid, the organs on either end of your stomach aren't as well equipped. Under certain conditions, acid spilling into your small intestine could cause a peptic ulcer. And acid rising into your esophagus -- what doctors call “gastroesophageal reflux” -- could cause heartburn or esophageal injury.

A Common Problem

Gastroesophageal reflux and heartburn are a part of life for many people. A 2008 review in "American Family Physician" reported that 44 percent of American adults complain of heartburn or regurgitation -- the hallmark symptoms of acid reflux -- at least once a month. Seven percent experience such symptoms every day. Children, too, are afflicted by acid reflux. According to a study published in the October 2011 issue of the "Journal of Gastrointestinal Surgery," up to 20 percent of the pediatric population is affected by gastroesophageal reflux disease.

Making Distinctions

Acid reflux causes a wide array of symptoms. Intermittent gastroesophageal reflux, or GER, may trigger heartburn as gastric acid washes over the tender inner lining of your lower esophagus. Gastroesophageal reflux disease, or GERD, is a term used to describe recurrent heartburn, acid-induced damage of the lower esophageal lining or persistent “extra-intestinal” symptoms of acid reflux, such as chronic cough, wheezing, chest pain, hoarseness, chronic sore throat or eroded dental enamel. The line between GER and GERD is sometimes blurred. People with occasional heartburn don't necessarily have GERD, and not all patients with GERD report having heartburn. In many cases, GERD cannot be diagnosed without endoscopy, which involves direct visualization of your esophageal lining by passing a scope through your esophagus.

Esophageal Injury

The lining of your lower esophagus is unlike the inner lining of your stomach. It doesn't possess the thick layer of mucus and other cellular defenses to protect it from recurrent acid reflux. Over time, your esophagus may develop erosions, or ulcers, as a result of repeated acid exposure. In an attempt to protect themselves from backwashing stomach acid, the cells in your lower esophagus may transform and become more like the cells found in your stomach. This condition, called Barrett esophagus, may be a precursor to esophageal cancer. According to a 2012 review in the "World Journal of Gastroenterology," 5 to 15 percent of people with GERD eventually develop Barrett esophagus. People who have Barrett esophagus are 40 times more likely to develop esophageal adenocarcinoma, which is the most common form of esophageal cancer in the United States.


Although the most worrisome outcome of untreated GERD is esophageal cancer, your risk for developing cancer if you have Barrett esophagus is less than 1 percent per year. However, even if you don't develop such serious complications, GERD can negatively impact your quality of life in other ways. Esophageal erosions can bleed and cause anemia. Your sleep can be disrupted by recurrent nighttime reflux. And the extraesophageal symptoms of GERD can interfere with your work, sleep and social and leisure activities. GERD is treatable and many of the most effective agents for GERD treatment are available over the counter. H2 blockers, such as cimetidine (Tagamet) and ranitidine (Zantac), and proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid), are easy to get. Therefore, many people with heartburn treat themselves without seeing their physicians. Such self-treatment does carry its risks, though. You could develop a complication of GERD without being aware of it. If you have persistent heartburn despite using nonprescription medications, or if you have other symptoms that could be related to GERD, such as a persistent cough, difficulty swallowing, a sore throat that won't clear up or frequent nighttime awakening, see your doctor for an evaluation.