Is Acid Reflux Dangerous?

Acid reflux might seem like a temporary inconvenience, but long-term acid reflux can be dangerous.

Acid reflux can feel like your heart or chest is burning. If you’ve ever experienced acid reflux, you may have wondered if it was abnormal or dangerous.  

“Everyone has a little bit of acid reflux,” says John Lipham, MD, a gastrointestinal surgeon focused on benign and malignant diseases of the foregut. “But when acid reflux gets to a certain point, then that becomes what we call pathologic, meaning it’s a serious disorder.” 

In general, acid reflux affects about 20%-30% of people in the United States, so it’s a pretty common disorder, says Dr. Lipham, a leader of the USC Esophageal and Foregut Disorders Center, part of the USC Digestive Health Institute and Keck Medicine of USC. Bouts of acid reflux normally last between a few seconds to a few minutes, Dr. Lipham says. For most people, that is not a dangerous level. “But if you’re experiencing acid reflux more than a few times per week, and this has been going on for six months, a year or more, you really should see your doctor to see if you need to be evaluated to make sure you’re not developing damage to your esophagus,” he says.  

What is acid reflux?  

“Acid reflux is actually a mechanical problem,” Dr. Lipham says. “Commercials on TV lead you to believe that it’s a problem with the acid production of your stomach, but it really doesn’t have anything to do with the acid in the stomach. Everybody has the same amount of acid in their stomach.” 

The real cause of acid reflux is weakening of the barrier or valve at the end of the esophagus that allows food into the stomach but then prevents everything from coming back up, he explains. When that barrier or valve weakens, contents from the stomach, including acid, can come back up and cause you to feel heartburn or other less common symptoms of acid reflux.  

Is acid reflux dangerous? 

“Acid reflux indeed can be dangerous,” Dr. Lipham says. “We think of acid reflux as sometimes just an inconvenience of heartburn or whatever symptoms we may have after eating certain foods or drinking certain beverages. But the substances coming up from the stomach — acid, bile and other digestive enzymes — can actually damage the inside of the esophagus and sometimes lead to ulcerations of your esophagus.” 

Usually, if someone has chronic, recurring acid reflux, they will be diagnosed with a condition called GERD, or gastroesophageal reflux disease. When GERD progresses and the lining of the esophagus is changed by these acids and digestive enzymes of the stomach, it can also lead to a precancerous condition called Barrett’s esophagus, Dr. Lipham warns. Around 5% of people in the United States have Barrett’s esophagus. Barrett’s esophagus can then sometimes lead to esophageal cancer, which is one of the deadliest types of cancer. This is why it is so important to get your acid reflux examined by a doctor if you’re experiencing it frequently over the course of a few months, Dr. Lipham says.  

Who is more at risk for developing Barrett’s esophagus and esophageal cancer? 

“In general, males are a little more likely to develop Barrett’s esophagus or esophageal cancer than women are,” Dr. Lipham says. “About 20% of males with reflux will develop Barrett’s in their lifetime. The risk of Barrett’s progressing to cancer is estimated to be about 0.3%-0.5% per year. So, after 10 years, that’s about a 3%-5% chance that an individual may develop esophageal cancer.” 

Other factors can also play a part in the risk of developing dangerous acid reflux. People who are overweight or obese have a greater risk of developing acid reflux, with around 30%-50% of obese people developing acid reflux, he says. And since the esophageal barrier can weaken over time, older people are also at higher risk of developing dangerous acid reflux. 

Does what I eat worsen my acid reflux? 

“Early on with the disease, certain foods and beverages will worsen reflux,” Dr. Lipham says. “However, as the disease worsens due to the underlying genetic or connective tissue disorder, then we get to a point where it really doesn’t even matter what you eat. It becomes sort of a wide-open door down there, and everything comes up no matter what you eat.”  

How much acid reflux is dangerous?  

“The upper limit of normal acid reflux is considered anywhere from 30-50 episodes of reflux per day,” Dr. Lipham says. Most bouts of acid reflux are actually “silent,” he adds, meaning that a person doesn’t feel any symptoms of the reflux bout. This is why sophisticated testing is required to accurately determine how much reflux an individual is experiencing.  

“Even the most symptomatic individuals only feel about 10% of episodes of reflux,” Dr. Lipham says. “In other words, if you have 50 episodes of reflux in a day, even if you’re the most symptomatic patient, you’re only going to feel about five of those episodes. And ultimately, we don’t know how severe your reflux is unless you undergo these diagnostic tests.”  

The most important test for dangerous acid reflux is an upper endoscopy, an outpatient procedure where a camera is inserted down your throat to view your esophagus during a physical exam. “We can look for worrisome things, whether it’s inflammation of the esophagus, Barrett’s esophagus or even cancer,” Dr. Lipham says. “During that test, we also generally recommend doing something called pH testing. That’s where we put a little probe down in the esophagus that can measure exactly how much reflux a person has in a day.” 

“Upper endoscopies are the single most important test that will allow us to pick up damage at an early stage when we can actually do something about it,” Dr. Lipham stresses.  

Another warning sign of dangerous acid reflux is if food feels like it’s sticking on its way down to the stomach, a medical condition called dysphagia. “If a patient has dysphagia, they should seek medical attention immediately, because that can be a sign of either severe damage to the esophagus, such as significant esophagitis, inflammation, scar tissue or cancer,” Dr. Lipham says. 

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