The complications of gastroesophageal reflux disease (GERD) include both esophageal and extra-esophageal manifestations. The most relevant are peptic strictures, Barrett’s esophagus, and respiratory complications. Peptic strictures result from chronic untreated reflux causing inflammation and fibrosis with progressive dysphagia. Diagnosis is endoscopic, and first-line treatment is endoscopic dilation combined with acid suppression, whereas stent placement or steroid injection may be useful for refractory cases. Barrett’s esophagus is a pre-neoplastic condition characterized by columnar metaplasia secondary to chronic acid exposure, with an annual adenocarcinoma risk of 0.12-0.5%; management includes acid suppression, endoscopic surveillance, and radiofrequency ablation in case of high-grade dysplasia. Among the most relevant respiratory complications associated with GERD are post-lung transplant GERD, aspiration pneumonia, idiopathic pulmonary fibrosis, and refractory asthma. In lung transplant recipients, acid and non-acid reflux along with upper-foregut dysmotility are associated with chronic lung allograft dysfunction; early anti-reflux surgery may improve outcomes. In aspiration pneumonia, microaspirations of acid, pepsin, and bile acids are key mechanisms; treatment includes proton pump inhibitors (PPI), swallowing rehabilitation, and fundoplication in selected cases. In idiopathic pulmonary fibrosis, the GERD association is supported by genetic studies, although the benefit of PPI remains uncertain. In refractory asthma, the relationship is bidirectional; PPI provide modest benefit, and surgery should be reserved for objectively proven reflux. It is essential to objectively document pathological reflux and rule out esophageal motor disorders prior to therapeutic interventions. Potassium-competitive acid blockers remain under investigation but are promising future therapeutic options.
Keywords: Gastroesophageal reflux disease. Peptic stricture. Barrett??s esophagus. Aspiration pneumonia. Idiopathic pulmonary fibrosis. Refractory asthma.
