**9. Complications**

As already stated, untreated or unrecognized reflux episodes can be connected with a number of potential medical complications and health-threatening and life-threatening consequences. The prevalent complications of GERD include dysphagia, bleeding from erosive esophagitis, and esophageal adenocarcinoma. Dysphagia usually occurs slowly in patients with long-standing heartburn. The most common causes are peptic stricture and severe inflammation, but dysphagia can be the first symptom of pathological esophageal mucosa changes and esophageal cancer. It is considered an alarming symptom in patients with GERD that requires endoscopy [31].

Severe esophagitis is a risk factor for development of Barett's esophagus (BE). Barrett's esophagus is a condition defined as a metaplastic transformation of the distal normal esophageal squamous epithelium into the columnar epithelium. It is considered a premalignant condition, the only known predisposing factor of epithelial dysplasia and esophageal carcinoma. Long-term and non-treated gastroesophageal reflux disease is the most important risk factor for the development of this condition. BE is found in 1.3–1.6% of the general population and 5–15% of symptomatic GERD patients undergoing endoscopy.

The incidence of GERD has been increasing significantly over the last few decades, as well as incidence of adenocarcinoma of the esophagus. As BE is the only known precursor to carcinoma, progress in the monitoring and therapy of BE are essential to enable early diagnosis and improve patient outcomes.

Lower esophageal rings (Schatzki) correlate with reflux esophagitis, too. Other complications include anemia (due to chronic blood loss), peptic ulceration, and a whole range of respiratory tract problems [32].

Laryngeal and pharyngeal mucosa has a poor self-protection capacity and poor adaptability to chemical stimuli. Some significant long-term complications of LPR are chronic otitis media, chronic rhinosinusitis, oral cavity disorders and dental erosions, recurrent bronchopulmonary infections, and cardiac problems. More serious, but not so often, laryngeal findings in patients with LPR include vocal cord nodules, laryngospasms, subglottic stenosis, and arytenoid fixation. LPR is also an independent risk factor for squamous cancer of the larynx and pharynx. Pepsin has been linked to epithelial proliferation and carcinogenesis. Namely, activated pepsin induces inflammation, destruction of the epithelial defense barrier, changes in expression of laryngeal and hypopharyngeal genes and tumorogenesis, and disruption of the function of epithelial cells [33–36]. Some studies have shown that bile acids and Helicobacter pylori may play a role in the development of laryngeal and hypopharyngeal carcinoma.

*The Differences between Gastroesophageal and Laryngopharyngeal Reflux DOI: http://dx.doi.org/10.5772/intechopen.106418*
