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Complications
By Mayo Clinic staffA sticky mucous coating protects the lining of your stomach from the corrosive effects of stomach acid, but the esophagus doesn't have this protection. This lack of protection is why bile reflux and acid reflux can seriously damage esophageal tissue. And although bile reflux can injure the esophagus on its own, the combination of bile and acid reflux seems to be particularly harmful, increasing the risk of complications, such as:
- Heartburn and gastroesophageal reflux disease (GERD). Occasional heartburn usually isn't a concern, although a severe episode can mimic a heart attack. But frequent or constant heartburn is the most common symptom of gastroesophageal reflux disease (GERD), a potentially serious problem that causes irritation and inflammation of esophageal tissue (esophagitis).
- Esophageal narrowing (stricture). Repeated exposure to stomach acid, bile or both can cause scar tissue to form in the lower esophagus. This narrows the tube, interfering with swallowing and increasing the risk of choking.
- Barrett's esophagus. In this serious condition, long-term exposure to stomach acid or a combination of acid and bile causes a change in the color and composition of the tissue in the lower esophagus (metaplasia). The cells resemble glandular tissue in the small intestine — under a microscope, they look like shag carpeting — and although they're resistant to stomach acid, they have increased potential for malignancy.
- Esophageal cancer. This serious form of cancer can occur almost anywhere along the length of the esophagus, and it may not be diagnosed until it's quite advanced. The possible link between bile and acid reflux and esophageal cancer remains controversial, but many experts think a direct connection exists. In animal studies, bile reflux alone has been shown to cause cancer of the esophagus.
- Gastritis. In addition to causing irritation and inflammation in the esophagus, bile reflux can cause stomach irritation (gastritis). Although not always serious, untreated gastritis can lead to stomach ulcers and to bleeding, a potentially life-threatening problem that requires immediate medical care. Chronic gastritis can also increase the risk of stomach cancer.
References
- Mercer DW, et al. Peptic ulcer disease. In: Townsend CM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/169271004-2/0/1565/453.html?tocnode=54738708&fromURL=453.html. Accessed Oct. 15, 2009.
- Lee EL, et al. Gastritis and gastropathies. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/165017723-5/902729765/1389/357.html#4-u1.0-B1-4160-0245-6..50054-8--cesec51_2169. Accessed Oct. 15, 2009.
- Dawson PA. Bile secretion and the enterohepatic circulation. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/1650177237/0/1389/450.html?tocnode=51640881&fromURL=450.html#4-u1.0-B1-4160-0245-6..50066-4_2774. Accessed Oct. 15, 2009.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed Oct. 15, 2009.
- Yardley JH, et al. Acute hemorrhagic erosive gastropathy and chronic chemical gastropathy. http://www.uptodate.com/home/index.html. Accessed Oct. 15, 2009.
- Fass R. Approach to refractory gastroesophageal reflux disease in adults. http://www.uptodate.com/home/index.html. Accessed Oct. 15, 2009.
- Kiefer D. Gastroesophageal reflux disease. In: Rakel RE. Integrative Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/165168078-5/903199144/1494/89.html#4-u1.0-B978-1-4160-2954-0..50046-6_2173. Accessed Oct. 15, 2009.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 24, 2009.
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