GERD is a very common ailment among the US population. Not only is it inconvenient and uncomfortable, but GERD also can create more serious complications when unmanaged or untreated. Prolonged exposure to gastric acid in the esophagus, due to frequent and longstanding GERD, can have severe complications on the esophageal tract and its surrounding organs. These complications can include:
- Erosive esophagitis
- Severe narrowing (stricture) of the esophagus
- Barrett’s esophagus
- Cancer of the esophagus
Erosive esophagitis develops in chronic GERD patients when acid irritation and inflammation cause extensive injuries to the esophagus. Remember that the lining of the esophagus is very thin and fragile, and not built to withstand strong stomach acid. Continuous reflux of acid in the esophagus causes the mucosal lining to wear down in places. Esophagitis can lead to scarring of the esophagus, which might cause difficulty swallowing.
Barrett’s esophagus is a more serious complication of GERD, and often develops as an advanced stage of erosive esophagus. Studies show that about 12% of GERD patients have Barrett’s in their esophagus.
In Barrett’s, the normal cells in the esophageal lining transform into different cells. Normally, the esophageal lining consists of flat, layered cells similar to those in the skin. These cells are called the squamous epithelium. This lining stops at the lower esophageal sphincter, where the esophagus joins the stomach and digestive tract. The lining of the stomach and the rest of the digestive tract is made up of tall, rectangular cells, called the columnar epithelium. These cells provide more protection against the erosive nature of stomach acid than the cells in the esophagus.
What happens in Barrett’s is the chronic occurrence of GERD (in severe cases) causes the cells in the esophageal lining to convert into a different type of cell, in a process called metaplasia. This can happen when the original cells are not robust enough to withstand their environment (i.e., the recurrent reflux of gastric acid into the esophagus), and then transform into another cell type better suited to their environment. The new cells resemble the columnar cells that are in the lining of the colon and intestines, built to withstand gastric acid. When this happens, the esophageal lining now has patches of new cells, while the rest of the lining contains the original squamous cells. This process of cell conversion predisposes the cells to cancer.
Cancer in the esophagus typically occurs in one of two forms: squamous cell cancer and adenocarcinoma. Squamous cell cancer attacks the normal cells of the esophagus, while adenocarcinoma attacks the altered cells of Barrett’s. Changes in the lining cells can range from minor to significant (low-grade dysplasia), to serious or very abnormal changes (high-grade dysplasia)
Squamous Cell Cancer
Squamous cell cancer occurs in the normal cells of the esophagus, and is the predominant type of esophageal cancer worldwide. Research shows that the incidence of this type of cancer increases with age and peaks in one’s 70s. Squamous cell cancer occurs in the middle to lower third of the esophagus. The upper esophagus is a rare site for esophageal cancer. Squamous cell cancer tends to occur when the normal squamous cells of the esophageal lining are chronically irritated and inflamed by an outside factor, and begin to replicate or mutate abnormally as a consequence. Such outside factors include excessive alcohol intake and smoking, as well as consumption of red meat, low intake of fruit and vegetables, and poor oral health. In fact, there is a direct correlation between the number of cigarettes a smoker smokes per day, the length of time a smoker spends smoking, and the risk of contracting esophageal cancer. Squamous cell cancer is typically treated with radiotherapy or surgery.
Cancer may develop in the patches of altered, columnar cells of Barrett’s esophagus. This occurs when the cells begin to replicate, divide, or mutate in an abnormal manner. This type of cancer occurs in the lower third of the esophagus, as this is where Barrett’s usually develops. Patients with Barrett’s esophagus have a 50-100 times increased risk of developing esophageal cancer compared to the general population. A 2002 study demonstrated that the risk of adenocarcinoma increased with the length of Barrett’s esophagus, and also with the severity of acid reflux. Unlike squamous cell carcinoma, however, the risk of adenocarcinoma and high-grade dysplasia has not shown to be affected by smoking and alcohol consumption.
What does this mean for my VA claim?
If you are already service-connected for GERD, and you have complications caused by GERD as mentioned above, you can file a claim for benefits secondary to the condition that has already been service connected. For example, if you have Barrett’s Esophagus, and it is obstructing your esophagus and causing difficulty with swallowing, you can file a claim for that condition secondary to GERD.
While the VA rating schedule is extensive, it does not cover everything. In the event that the Barrett’s Esophagus was granted service-connection, the VA would rate it under the diagnostic code that most closely resembled the condition. In this case, they would probably rate it under Diagnostic Code 7203: “Esophagus, structure of”. The minimum rating for this is 30%. The same would apply for other conditions related to the esophagus, including cancers.