Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
GERD causes Barrett's esophagus. The esophagus is a
muscular tube that is located in the chest and serves to transfer food from the
mouth to the stomach. The lower esophageal sphincter (LES) is a valve that is
located at the junction of the stomach with the esophagus . Its function is to
prevent acid and other contents of the stomach from coming back into the
esophagus. GERD is a condition in which excessive acid-containing fluid refluxes
(flows) back into the esophagus, in part because the lower esophageal sphincter
is weak. The weakness of the LES may be related, in part, to the fact that
virtually all GERD patients have hiatal hernia. In hiatal hernia, the upper few
centimeters of the stomach slides back and forth between the abdomen and the
chest through the diaphragm. This sliding may interfere with how the sphincter works as a barrier to reflux from the stomach to the esophagus.
Previously, the term hernia was used instead of GERD in explaining to patients the basis of their symptoms (usually heartburn) because virtually all GERD patients have hiatal hernias. GERD, however, is the more accurate term. Hiatal hernias are extremely common in the population and yet only a small number of people with
hiatal hernia develop GERD. In other words, the presence of a hiatal hernia does not mean that the person will develop GERD. On the flip side, however, if a person has GERD, hiatal hernia is almost always present.
Thus, Barrett's esophagus is caused by chronic (of many
years duration) and usually severe acid reflux. In some patients with GERD, the
esophagus reacts to the repeated injury from the acidic fluid by changing the type of cells lining it from squamous (normal cells) to columnar (intestinal-type cells). This transformation, called metaplasia, is believed to be a protective response because the specialized columnar epithelium (epithelium means lining) in Barrett's esophagus is more resistant to injury from acid than the squamous epithelium.
Picture of gastroesophageal reflux disease (GERD)
Other contributors to Barrett's esophagus
The fluid in the stomach contains acid that is produced by the stomach. In addition, however, the fluid may contain bile acids (from bile produced by the liver) and enzymes (produced by the pancreas) that have refluxed back from the duodenum into the stomach. (The duodenum is the first part of the small intestine just beyond the stomach.) The acid that refluxes from the stomach to the esophagus is injurious to the esophagus. There is some evidence, however, that the bile and pancreatic enzymes combined with the acid may be more injurious than acid alone.
Who develops Barrett's esophagus?
Approximately 10% to 15% of individuals with chronic symptoms of GERD develop Barrett's esophagus, and it is estimated that Barrett's esophagus may affect as many as
one in 100 to one in 500 individuals in the general Caucasian population, especially among males. Not everyone with GERD has symptoms of GERD, however. Therefore, some people with Barrett's are unaware that they have Barrett's because they have GERD without any symptoms at all or have very mild and infrequent symptoms.
It is unclear why Barrett's esophagus is so
overwhelmingly more common in white males than in any other group. For example,
although women and African-Americans do not seem to be protected from developing
GERD, they are largely protected (especially African-Americans) from developing
Barrett's esophagus and Barrett's cancer (adenocarcinoma). There is evidence
that in the western hemisphere, esophageal cancer and cancer of the
gastroesophageal junction (called cardia cancer) are increasing in frequency,
perhaps more so than any other gastrointestinal tract cancer. (You should know,
however, that colon cancer is still very much more common than esophageal cancer.)
Barrett's esophagus may run in some families and be
genetically determined. Studies are underway to determine if any genes or markers can be found in these families that would predict the development of Barrett's esophagus in the general population. In these families with Barrett's as well as with Barrett's in the general population, GERD is the common denominator. However, the question is why the Barrett's occurs more commonly in these families than in others with comparably severe GERD, but with no family association.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Causes of hiatal hernia are a larger than normal esophageal hiatus. There are two types of hiatal hernias, sliding, or para-esophageal. When symptoms of hiatal hernia appear, they are similar to GERD symptoms. Hiatal hernia treatment is generally surgery.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Hoarseness (abnormal deep, harsh, raspy voice) is caused by a variety of conditions in which the larynx (voice box and vocal chords) are irritated or injured. Examples of causes of hoarseness include: laryngitis, straining the vocal cords by yelling or screaming, infections, GERD, allergies, and more. Treatment of hoarseness depends on the cause.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
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