Bleeding. Bleeding may occur in about 8% of patients with erosive esophagitis. In very severe cases, people may have dark-colored, tarry stools (indicating the presence of blood) or may vomit blood, particularly if ulcers have developed in the esophagus. This is a sign of severe damage and requires immediate attention.
Sometimes long-term bleeding can result in iron-deficiency anemia and may even require emergency blood transfusions. This condition can occur without heartburn or other warning symptoms, or even without obvious blood in the stools.
Barrett's Esophagus and Esophageal Cancer
Barrett's esophagus. Barrett's esophagus (BE) leads to abnormal changes in the cells of the esophagus, which puts a patient at risk for esophageal cancer.
About 10% of patients with symptomatic GERD have BE. In some cases, BE develops as an advanced stage of erosive esophagitis. While obesity, alcohol use, and smoking have all been implicated as risk factors for Barrett's esophagus, their role remains unclear. Only the persistence of GERD symptoms indicates a higher risk for BE.
Not all patients with BE have either esophagitis or symptoms of GERD. In fact, studies suggest that more than half of people with BE have no GERD symptoms at all. BE, then, is likely to be much more prevalent and probably less harmful than is currently believed. (BE that occurs without symptoms can only be identified in clinical trials or in autopsies, so it is difficult to determine the true prevalence of this condition.)
The incidence of esophageal cancer is higher in patients with Barrett's esophagus. Most cases of esophageal cancer start with BE, and symptoms are present in less than half of these cases. Still, only a minority of BE patients develop cancer. When BE patients develop abnormalities of the mucus membrane cells lining the esophagus (dysplasia), the risk of cancer rises significantly. There is some evidence that acid reflux may contribute to the development of cancer in BE.
Complications of Stricture
If the esophagus becomes severely injured over time, narrowed regions called strictures can develop, which may impair swallowing (a condition known as dysphagia). Stretching procedures or surgery may be required to restore normal swallowing. Strictures may actually prevent other GERD symptoms, by stopping acid from traveling up the esophagus.
Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.