The complications of GORD

With repeated exposure of the mucous membrane of the distal oesophagus to acid from the stomach, damage to the mucous membrane occurs. This is in effect a chemical burn wound of the distal oesophagus, which can vary from slight redness and inflammation to severe damage with chronic ulceration.

The damage can extend to the muscular layers of the oesophagus, and this may lead to inefficient contraction of the oesophagus. This results in weakened peristaltic contractions. The oesophagus attempts to heal, and like any other wound and particularly burn wounds, this results in scar formation. Scar formation in the oesophagus causes contraction in the length and breadth of the organ. These changes can lead to stricture and even shortening of the oesophagus.

Reflux can lead to inflammation, ulcers, and narrowing of the oesophagus.

Stricture as the consequence of chronic ulceration of the oesophagus due to an hiatus hernia with reflux.

Barrett's oesophagus

In 10 to 15% of patients with long standing and chronic reflux, the oesophageal mucous membrane undergoes such damage that the mucous membrane undergoes change in its cell structure to a form nearer to that of stomach mucous membrane in an attempt to pro-tect itself. This process is known as Barrett's oesophagus. In a small percentage of cases this abnormal mucous membrane can lead to cancer of the oesophagus. When Barrett's oesophagus is present the risk of cancer of the distal oesophagus is increased by 30 to 40 times more than the normal population. Figures as high as 10% incidence of oesophageal cancer have been reported in the medical literature. For this reason it is important to follow up cases of Barrett's oesophagus on a one or two year basis with repeated gastrosco-pies. During the examination a biopsy of the mucous membrane is taken and sent for histo-pathological examination. In this way it can be determined whether any undesirable changes have occurred. If such is the case, the Barrett's oesophagus can be treated timeously.