Le gastroesophageal reflux refers to the ascent of part of the contents of the stomach into theesophagus (the duct connecting the mouth to the stomach). The stomach produces gastric juices, which are very acidic substances that help in the digestion of food. However, the lining of the esophagus is not designed to resist the acidity of the contents of the stomach. Reflux therefore causes inflammation of the esophagus, which results in burning and irritation. Over time, damage to the esophagus can ensue. Note that a low level of reflux is normal and inconsequential, and this is referred to as physiological (normal) reflux.

Causes

In most people who have it, reflux is caused by poor functioning of the lower esophageal sphincter. This sphincter is a muscle ring located at the junction of the esophagus and the stomach. Normally, it is tight, preventing stomach contents from moving up to the esophagus, opening only to allow ingested food to pass through and thus acting as a protective valve.

In the event of reflux, the sphincter opens at the wrong times and lets the gastric juices of the stomach. People who suffer from reflux often have acid regurgitation after a meal or at night. This regurgitation phenomenon is very common in infants, because their sphincter is immature.

Gastroesophageal reflux disease can also be linked to hiatal hernia. In this case, the upper part of the stomach (located at the junction of the esophagus) “goes up” with the esophagus into the rib cage through the opening of the diaphragm (the hiatal orifice). 

However, hiatus hernia and gastroesophageal reflux disease are not synonymous, and hiatus hernia is not always associated with reflux.

Prevalence

In Canada, it is estimated that 10 to 30% of the population would be bothered by occasional episodes of reflux gastroesophageal⁷. And 4% of Canadians would have daily reflux for 30% once a week (13).

An American study shows that 44% of people have gastroesophageal reflux disease at least once a month ().

Regurgitation is extremely common in infants, but it is not always due to gastroesophageal reflux disease. Experts estimate that 25% of infants have a true reflux⁸. It reaches its maximum around the age of 4 months⁹.

Evolution

In the majority of affected adults, symptoms of reflux are chronic. Treatments most often provide complete, but temporary, relief of symptoms. They do not cure the disease.

In infants, reflux usually goes away between 6 and 12 months as the child gets older.

Complications

Prolonged exposure of the esophagus to acidic gastric substances can cause:

• Inflammation (oesophagite), with more or less deep lesions of the esophagus responsible forulcers (or sores) on the wall of the esophagus, which are graded in 4 stages, according to their number, their depth, and their extent;
• this inflammation or ulcer can cause hemorrhage ;
• narrowing of the diameter of the esophagus (peptic stenosis), which causes difficulty swallowing and pain during swallowing;
• un Barrett’s esophagus. It is the replacement of cells in the wall of the esophagus by cells that normally evolve in the intestine. This replacement is due to repeated “attacks” of stomach acid in the esophagus. It is not accompanied by any particular symptoms, but can be detected by endoscopy because the normal gray-pink color of the tissues in the esophagus takes on an inflamed salmon-pink color. Barrett’s esophagus puts you at risk for ulcers and, more importantly, cancer of the esophagus.

Gastroesophageal reflux disease can also lead to complications from a distance¹⁰ :

• chronic cough 
• a hoarse voice
• a laryngospasme
• cancer of the esophagus or larynx in case of uncontrolled and unmonitored reflux

When to consult?

In each of the situations below, it is advisable to see a doctor.

• A burning sensation and acid regurgitation several times a week.
• Symptoms of reflux interfere with sleep.
• Symptoms return quickly when you stop taking antacid medications.
• The symptoms have lasted for over a year and have never been evaluated by a doctor.
• There are some alarming symptoms (see the heartburn symptoms section).