Advanced stages of GERD involve worsening symptoms and can lead to complications that will also need treatment.
Gastroesophageal reflux disease, commonly called GERD, is a chronic condition that happens when the acids in the stomach back up into the esophagus. There are several stages of GERD, ranging from mild to severe.
This article discusses the advanced stages of GERD, how it progresses, the diagnosis process, and more.
GERD presents in stages.
The symptoms a person experiences help a doctor with staging GERD in a person.
There are four stages of GERD. They are:
- Stage 1 (mild): A person has infrequent heartburn and regurgitation happening once or less each week.
- Stage 2 (moderate): A person has regurgitation or heartburn occurring a few times a week.
- Stage 3 (severe): A person has regular heartburn, a chronic cough, regurgitation, a hoarse voice, and regurgitation of food.
- Stage 4 (esophageal cancer or precancerous lesions): A person has the same symptoms as stage 3, plus food getting stuck in the back of their throat when eating.
About 10% of people living with unmanaged reflux will advance to stage 4 GERD.
GERD occurs when the sphincter in the lower esophagus weakens or relaxes when it should not. Several factors can lead to the development of GERD,
- having obesity or overweight
- secondhand smoke and smoking
- side effects of certain medications, such as calcium channel blockers, benzodiazepines, tricyclic antidepressants, certain asthma medications, and nonsteroidal anti-inflammatory drugs
Advanced stages of GERD occur when a person’s acid reflux goes untreated for a long period of time. About 15% of people living with GERD are at stage 3, while about 10% of people living with GERD will progress to stage 4.
Symptoms of stages 3 and 4 are similar, and include:
- regurgitation of liquid or food
- chronic cough
- sore throat
- hoarse voice
At stage 4, a person may also develop dysphagia, which means food gets stuck in the esophagus when eating.
- loss of appetite
- pain in the chest
- problems with swallowing or pain when swallowing
- persistent vomiting
- unexplained weight loss
- bloody, black, or tarry stool, which indicate bleeding in the digestive tract
- vomit that looks bloody or as though it contains coffee grounds
A person should contact their doctor if they experience worsening or more frequent symptoms.
In many cases of GERD, a doctor will diagnose a person by reviewing the symptoms they are experiencing. A doctor
If a person’s symptoms do not ease with medication and lifestyle changes, or their symptoms indicate a complication from GERD, a doctor may recommend testing. Testing can help a doctor diagnose GERD and check for complications.
Tests may include:
- an endoscopy, which is a procedure where a doctor inserts a small camera into the esophagus to check for causes of a person’s symptoms and signs of complications
- esophageal pH monitoring, which is an accurate way to check for GERD that checks for the presence of acid in the esophagus
Advanced stages of GERD increase a person’s risk of developing potentially serious complications. Some common complications
- Barrett’s esophagus, a condition where tissue similar to the small intestine develops in the esophagus and can lead to cancer
- chronic cough
- wearing down of tooth enamel
- esophageal stricture, the narrowing of the esophagus
- esophagitis, inflammation in the esophagus that can lead to ulcers or bleeding
Treatment typically involves a combination of medical interventions and lifestyle changes.
- over-the-counter or prescription antacids
- acid reducers such as H2 blockers or proton pump inhibitors
- surgery such as fundoplication (sewing the top of the stomach around the esophagus) or bariatric surgery (weight loss surgery)
In addition to medications and other treatments, a doctor will likely recommend lifestyle changes. These can include:
- quitting smoking
- reaching a weight that is healthy for the person
- making changes to eating habits and diet
- elevating the head during sleep
For advanced stages, a person should contact a GERD specialist regularly to monitor their treatment. The specialist can modify treatment and help prevent complications from developing.
With effective management, a person living with GERD can maintain a high quality of life and continue their typical daily activities.
Severe complications are rare, and most people will find symptom relief with lifestyle changes and medications.
Advanced stages of GERD typically present with worsening and more frequent symptoms as well as a higher risk of developing complications.
Treatment often involves a combination of lifestyle changes and medications. In some cases, a doctor may recommend a surgical procedure.