Consequences of Untreated GERD Ignoring GERD can be dangerous. The effects of untreated GERD include esophagitis, an inflammation of the esophagus due to chronic exposure to stomach acids, which can lead to bleeding, esophageal ulcers, and potentially cancer. GERD that isn’t treated can also lead to difficulty swallowing due to the narrowing of the esophagus from the buildup of scar tissue. “Chronic acid exposure in the esophagus can be associated with the potential for esophageal cancer,” says Eric Esrailian, MD, MPH, section head of the department of general gastroenterology at the University of California, Los Angeles. To reduce the chances of these complications, people with GERD often have to take medication for several months or more. Even after their symptoms have disappeared and the esophagus has healed, many patients need to continue taking their GERD medicine. “GERD is a relapsing disease,” says Dr. Esrailian. “To prevent recurrence and further damage to the esophagus, people may have to stay on the drugs for years, even for life.” Risks of Long-Term GERD Treatments The risks of repeated episodes of GERD are clearly undesirable; but, are there any risks to staying on GERD medications over the long-term? Simply put, yes. Risks of taking long-term GERD medication include:
Esophageal cancer. Taking over-the-counter (OTC) antacids has been associated with an increase in risk for esophageal adenocarcinoma, a form of cancer. According to a recent study, people who took OTC antacids for more than three years (and weren’t under a doctor’s supervision) had a risk of esophageal adenocarcinoma that was six times higher than the risk for people who had never taken antacids.Weakened bone density. Proton pump inhibitors, or PPIs, the newest class of GERD medication, are so effective against GERD that they can eliminate symptoms and heal the esophagus in almost all GERD patients. However, emerging research may point to a downside for people who need to take PPIs for a lengthy time period. “There is some evidence, although it is controversial, that using PPIs for years can affect bone density,” says Esrailian. Weakened bone density can lead to an increased risk of bone fractures. “The research is not extensive enough to suggest that people should not take these medications, but each individual should talk with their doctor,” Esrailian says. In May 2010, the U.S. Food and Drug Administration announced that labels for OTC and prescription PPIs must be revised to include information about the increased risk of hip, wrist, and spine fractures associated with these drugs.
Long-Term GERD Treatment: Weighing the Risks Which GERD drugs should be used for a long time is a decision based on each individual’s past and present medical history. The doctor and patient should discuss the pros and cons of long-term medication use together. “There are some patients whose GERD is so severe that they clearly need to be on long-term medication," Esrailian says. “On the other hand, some GERD patients are put on long-term medication when their symptoms are just intermittent,” he notes. “In those cases, I might choose to offer the option of taking a medicine on an as-needed basis, instead.” The fact of the matter is that there are risks and benefits to most drugs. Talk to your doctor about the pros and cons of long-term GERD medication use based on your unique situation and together, you can come up with the best treatment plan for you.
