Acid reflux, more correctly known as gastroesophageal reflux disease (GERD), is the most common upper gastrointestinal complaint in all age groups. It becomes more common with advancing age and the elderly are therefore more prone. Although most of us look at heartburn, the main symptom of GERD, as nothing more than an inconvenience, reflux can cause some serious complications. It is in the very young and the elderly where the complications of GERD can be a major problem.
Due to the circadian clock and the sleeping position, GERD is often worse at night. The production of gastric acid increases at night and lying flat when sleeping facilitates an easier passage for the acidic stomach contents to pass up the food pipe. Therefore heartburn is typically felt more intensely at night. It is one of the common, yet under diagnosed, reasons for difficult sleeping at night. Although sleeping problems can have severe consequences, there are other complications that are also more likely to arise. This mainly involves the esophagus and respiratory system of the body.
Severe GERD, even during the day or when upright, can also cause the complications discussed below. However, heartburn when awake may prompt a person to undertake measures such as using antacids to neutralize the acid. Furthermore, the body has its own mechanisms such as excessive salivation and strong esophageal contractions to neutralize the stomach acid in the esophagus or push the acid back down into the stomach. Therefore a person is at a greater risk of complications from GERD at night while asleep. Although the esophagus is more widely damaged by the acid, it is in the respiratory tract where the more serious complications may arise.
The lower respiratory system and the gastrointestinal system share a common passageway – the throat. In severe GERD, the acidic stomach contents can reach as high as the throat and even empty into the lower airways. Normally the epiglottis and cough reflex prevent stomach acid from entering or remaining in the airways where it can cause damage. However, while asleep these preventative measures may not be as effective particularly in the elderly who may have a host of other disease that can compromise these mechanisms.
GERD can therefore lead to laryngitis (inflamed voice box), tracheitis (inflamed windpipe), bronchitis (inflamed bronchi that lead to the lungs) and pneumonia (lung inflammation). Bronchitis and pneumonia can be two very severe respiratory tract conditions that can complicate further and even lead to fatal consequences. The elderly with a weaker immune system and underlying chronic diseases are therefore at a greater risk. Initially it is the stomach acid and strong digestive enzymes that inflame and damage the bronchi and lung tissue. However, this damage can increase the chance of infections thereby further aggravating the bronchitis and pneumonia.
Should the acidic stomach contents reach higher, it can also cause a sore throat (tonsillopharyngitis) or even leak into the nose (rhinitis) and sinuses (sinusitis). Typically the symptoms if these conditions are worse in the morning. While these complications may not be as dangerous as severe bronchitis or pneumonia, it can nevertheless cause significant discomfort and become further complicated with an infection. Even the middle ear may be affected as the Eustachian tube that runs from the back of the throat to the middle ear may become inflamed. The stomach acid may not reach the middle ear but an inflamed Eustachian tube blocks the passage for air equalization and drainage. Ear pain and fluid accumulation in the middle ear may then arise.