COVER STORY

GERD BEYOND THE ESOPHAGUS

Researchers are finding that acid reflux can touch off asthma, laryngitis, and even otitis media

As research into gastroesophageal reflux disease (GERD) continues, clinicians are discovering more about the disorder. New therapies, new sequelae, and new definitions are emerging. For starters, experts now believe GERD is not one disease but a group of several disorders.

Charles Ponte, Pharm.D., CDE, BC-ADM, explained that GERD has been separated into at least two separate disorders: erosive esophagitis (EE) and nonerosive reflux disease (NERD). Many people are now using GERD as an umbrella term for esophageal reflux disorders, said Liza Takiya, Pharm.D., CDE, BCPS, assistant professor of clinical pharmacy at the University of the Sciences in Philadelphia. However, another way to look at it is GERD applies to reflux with some esophageal structural changes, and NERD is reflux without these changes. In both cases, patients can be symptomatic or asymptomatic.

It is important to diagnose EE and NERD and get the symptoms under control promptly, Takiya said. Treatment of NERD can prevent reflux esophagitis, EE, and Barrett's esophagus. This is particularly critical with EE. Without proper treatment, EE can progress to more serious disorders. One of these, according to Ponte, a professor of clinical pharmacy and family medicine at West Virginia University, is stricture, a formation of scar tissue below the esophageal mucosa. The scar tissue narrows the esophagus, and this eventually causes swallowing difficulties. Left untreated, stricture can become so severe that even swallowing liquids is difficult.

Long-term EE can also progress to Barrett's esophagus. In Barrett's, some of the normal epithelium in the esophagus is altered and becomes columnar epithelium. In an unlucky few patients, these tissue changes develop into esophageal cancer, the most serious complication of acid reflux, said Ponte.

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