An expert guide to gastroesophageal reflux disease


Dr James East of Mayo Clinic Healthcare on the causes, symptoms and potential complications of a common digestive disorder

Gastroesophageal reflux disease, which occurs when acid comes up from the stomach into the far less acid-resistant environment of the oesophagus, is among the most common digestive disorders.

“Gastroesophageal reflux disease is when you have acid and chemical damage to the lining of the oesophagus,” says Dr James East, a gastroenterologist at Mayo Clinic Healthcare in London. Heartburn is one key symptom. Others might include a lump in the throat, difficulty swallowing, chest pain, a cough or worsening asthma-type symptoms. There can be more severe complications if the condition is ongoing and left untreated.

“Complications of reflux disease include oesophagitis, which is inflammation in the bottom of the oesophagus,” Dr East says. “If this is persistent, you can develop scarring and a stricture – a narrowing of the oesophagus.”

Dr James East of Mayo Clinic Healthcare

Dr James East of Mayo Clinic Healthcare

Reflux disease may trigger a change in the cells that line the lower oesophagus, causing Barrett’s oesophagus. This is a fairly common complication of reflux disease, in which the lining of the oesophagus becomes damaged by acid reflux, which causes it to thicken and redden. “The stomach is well designed to handle highly acidic conditions,” explains Dr East. “But the oesophagus is not designed to cope with acid. And so when acid comes up, that acid reflux damages the cells, replacing them with more acid-resistant cells that develop into Barrett’s oesophagus.”

While frequent heartburn may be a sign, many people with Barrett’s oesophagus have no symptoms. However, having Barrett’s oesophagus does increase your risk of developing oesophageal cancer, so people with the condition need to have regular check-ups to test for precancerous cells.

People at highest risk for Barrett’s oesophagus include those who:

  • Are white
  • Are over 50
  • Have a family history of Barrett’s oesophagus or oesophageal cancer
  • Smoke
  • Have excess abdominal fat

“If you are male and have long-standing reflux lasting more than five years and two of those risk factors, then you should have a screening endoscopy for Barrett’s oesophagus,” Dr East says, “The risk for women is lower and screening needs to be individualised.”

To screen for Barrett’s oesophagus, an endoscope (a lighted tube with a camera at the end) is passed down the throat to check for signs of changing oesophagus tissue. A biopsy is often done to remove tissue and confirm the diagnosis. Treatment depends on the extent of abnormal cell growth in your oesophagus and your overall health, but in the early stages can include lifestyle measures and medications to help reduce acid reflux and, therefore, the oesophageal acid exposure.