Esophageal erosion and ulcers caused by GERD

The backup, or reflux, of stomach acids and juices into the esophagus that occurs with gastroesophageal reflux disease (GERD) can wear away (erode) the lining of the esophagus and cause sores, called ulcers.

GERD is caused when stomach acid and juices reflux into the esophagus. This happens when the valve between the lower end of the esophagus and the stomach (the lower esophageal sphincter) does not close tightly. This reflux can cause irritation, inflammation, or wearing away of the lining of the esophagus, which is called esophagitis.

In severe cases, patches of the lining of the esophagus wear away completely, and ulcers may develop. Ulcers can be shallow or deep and can destroy the lining of the esophagus where they develop.

Treatment for ulcers in the esophagus usually means treating the GERD that caused the ulcer in the first place. Treatment for GERD usually involves one of two options:

• Medication. Long-term, often lifelong use of medications called proton pump inhibitors may be necessary. Proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), or rabeprazole (Aciphex), reduce the amount of acid produced in the stomach. This leaves less acid in the stomach juice so that if stomach juice backs up into the esophagus, it is less irritating. This allows the esophagus to heal. Other types of medications used to treat GERD—such as acid reducers like cimetidine (Tagamet), ranitidine hydrochloride (Zantac), or famotidine (Pepcid)—are not as effective at helping heal injuries to the esophagus or in preventing a recurrence.¹
• Surgery. Fundoplication surgery is the most common surgery used to treat GERD. During surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the lower esophageal sphincter, which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.

Both types of treatment are about equally effective.¹

Citations

1. Katzka DA, Rustgi AK (2000). Gastroesophageal reflux disease and Barrett's esophagus. Medical Clinics of North America, 84(5): 1137–1161.