Guide 11 of 13

GERD complications: oesophagitis, strictures and Barrett's oesophagus

What can happen when reflux goes untreated for years: oesophagitis, strictures, Barrett's oesophagus and oesophageal cancer, how likely they are, and who should be checked.

Written by the GERD.org editorial team · Last updated · How we write

Smiling doctor with a stethoscope at a desk

Photo: Vitaly Gariev on Unsplash

Most people with GERD never develop complications, especially when symptoms are treated. But years of acid exposure can damage the oesophagus, so it helps to know what to look out for and who should be checked.

Oesophagitis

Oesophagitis is inflammation of the lining of the oesophagus. It is found on endoscopy in a sizeable minority of people with reflux, and is graded from A (mild) to D (severe). It can cause pain, difficulty swallowing and, occasionally, bleeding. PPIs heal most cases within eight weeks. People with severe grades (C or D) usually need long-term treatment to stop it returning. See understanding your results.

Stricture (narrowing)

Repeated inflammation and healing can leave scar tissue that narrows the oesophagus. The main symptom is food, especially bread or meat, sticking on the way down. Strictures are treated by gently stretching the oesophagus during an endoscopy (dilatation) and with acid-reducing medicine to stop them coming back. New difficulty swallowing always needs prompt investigation.

Barrett's oesophagus

In Barrett's oesophagus, the normal lining of the lower oesophagus is replaced by a different type of cell, similar to the lining of the intestine. It is thought to be the body's way of adapting to long-term acid exposure. Barrett's causes no symptoms of its own and is found on endoscopy.

Barrett's oesophagus slightly increases the risk of oesophageal adenocarcinoma, a type of cancer. The risk for any one person is low: most people with Barrett's never develop cancer. Because of the small risk, people with Barrett's are usually offered regular surveillance endoscopies, with intervals based on the length of the Barrett's segment and the biopsy results. If early changes (dysplasia) are found, they can usually be treated during an endoscopy.

Who should be checked for Barrett's?

Guidelines differ in detail, but screening is generally considered for people with long-standing reflux symptoms plus several risk factors, such as:

  • being male
  • being over 50
  • being white
  • smoking now or in the past
  • carrying extra weight around the abdomen
  • a close relative with Barrett's oesophagus or oesophageal cancer

If several of these apply to you, ask your doctor whether an endoscopy is appropriate.

Oesophageal cancer

Long-term reflux is a known risk factor for oesophageal adenocarcinoma, but this cancer is uncommon and the vast majority of people with reflux will never develop it. The most important thing is not to ignore warning signs: difficulty swallowing, weight loss, vomiting blood, black stools, or new reflux after 55. Stopping smoking and reaching a healthy weight also lower the risk.

Other effects

  • Dental erosion from acid reaching the mouth.
  • Throat and chest problems, such as chronic cough, hoarseness and worsening asthma. See silent reflux.
  • Poor sleep from night-time symptoms.

Sources

  1. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56.
  2. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63(1):7-42.
  3. NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184). National Institute for Health and Care Excellence, 2014, updated 2019.
  4. National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Acid Reflux (GER & GERD) in Adults.