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Complications
By Mayo Clinic staffA sticky mucous coating protects your stomach from the corrosive effects of stomach acid, but the esophagus lacks this protection, which is why bile reflux and acid reflux can seriously damage esophageal tissue. And although bile reflux can injure the esophagus on its own — even when the pH of the reflux is neutral or alkaline — 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 new 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 a high 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 link between esophageal cancer and bile reflux and acid reflux remains controversial, but many experts think a direct connection exists. In animal models, 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.
