Gastro esophageal reflux disease (GERD) is considered the main cause of Barrett’s esophagus (BE). GERD results in BE, but the exact cause of GERD is still unknown, and the complications of BE and GERD are interrelated.
Roughly 5%–13% of patients with GERD symptoms are susceptible to develop BE over their lifetime. Several other factors of GERD such asseverity, frequency, and duration of the symptoms have a huge impact on increasing the risk of BE.
Gastro esophageal reflux disease
The upward regurgitation of the stomach acid to the esophagus is referred to as GERD. GERD can cause specific symptoms of BE and may harm the esophagus. The primary and most common symptom of GERD is identified as heartburn. Heartburn is usually a burning sensation in the chest that frequently arises from the bottom of the breastbone leading towards the upper chest. These indications can be associated with excessive salivation in the mouth, dysphagia (discomfort in swallowing food), and burping.
All the above symptoms can be positional and may become severe when lying down. Symptoms of GERD can worsen when consuming alcohol, fatty food, acidic food, peppermint, and juices with citric content. These symptoms have a prolonged association with acid reflux disorder. While these symptoms have a long-term association with reflux disease, there is now a growing concern about other symptoms that can be caused by reflux disease. These symptoms are known as the extra-esophageal symptoms of reflux disease such as sleep disorders, asthma, laryngitis, halitosis, and chronic cough.
Complications of GERD and BE
BE is a condition in which the tissue in the esophagus appears like the tissue that lines the intestine. It is known as the precancerous intestinal metaplasia (Dysplasia) of the lower esophagus mucosa, which develops in response to chronic exposure to the acidic contents of the stomach. The adenocarcinoma caused by BE is increasing by 30 to 40 times each year.
BE is a complication of GERD. Patients affected by GERD symptoms at an early age are more prone to develop esophageal adenocarcinoma. It is uncertain that the risks for BE related with GERD indication depend only upon age. Furthermore, risks of esophageal adenocarcinoma linked with GERD symptoms are greater for people who are obese or a chain smoker. The potential modifiers of BE are still unclear; hence, there might be many other elements that might regulate the reaction of GERD with the risk of BE.
Risk of BE in GERD
GERD symptoms are more frequently observed in BE patients than in non-BE people. The risk of BE increases with prolonged increase in the frequency of GERD. Studies performed to analyze the association between symptoms related to age and risk of BE found that the huge risk of BE is observed in the people with long-term GERD symptoms at an early age of onset. By comparing patients of different age groups without GERD symptoms, it has been identified that the people aged 30 years or less with frequent symptoms of GERD are at greater risk of BE than those aged between 30 and 49 years and 50 to 79 years.
Another analysis which was performed to study the relationship between age of onset of heartburn and risk of BE identified that both GERD and heartburn had a similar pattern of association with BE risk.
The risk of BE is mainly associated with the severity of the symptoms of the GERD. It has been identified that patients with GERD symptoms had 12-fold greater risk of developing BE when compared to those without GERD symptoms. Age of onset for higher risk of BE was found to be 30 years in patients with severe GERD symptoms, but these results were not statistically reliable as they overlapped with each other.
GERD symptoms (cumulative)
The powerful linear trend of increasing BE risk is linked with a rising cumulative GERD duration of the indications. In the case of patients with GERD symptoms, the risk of BE is increased to 30% with every ten additional years of the exposure. Patients of less than 20 years of age with prolonged cumulative GERD symptoms and patients of 30 years of age with recurring GERD symptoms had a similar risk of BE when compared with patients who developed later in their lifetime. As the age of onset varies continuously, it has been observed that an early age at onset of GERD symptoms are significantly related to the risk of BE.
Esophagus adenocarcinoma is reported as the fatal condition that becomes common in several countries (United States, Industrialized nations, Australia, and Western Europe). Most of all cases of esophageal adenocarcinoma are reported to emerge with Barrett's Esophagus than GERD. The number of BE cases reported has risen drastically during the last few decades.
Reviewed by Afsaneh Khetrapal Bsc (Hons)