Review article: the risks of oesophageal acid exposure ‐ from minimal mucosal changes to malignancy

Gastro‐oesophageal reflux disease is very common and presents with a spectrum of symptoms with or without oesophageal damage. Gastro‐oesophageal reflux disease has an adverse impact on quality of life, especially in those with nocturnal symptoms. Prolonged exposure of the oesophageal mucosa to acidic gastric contents with pepsin and bile increases the risk of oesophageal mucosal injury. The frequency and severity of symptoms and oesophagitis correlate with the frequency, severity and duration of acid exposure, particularly at night‐time. This study reviews the mechanisms and evidence for acid‐induced symptoms and oesophageal injury, from superficial mucosal injury to Barrett's oesophagus and the long‐term risk of oesophageal adenocarcinoma. Optimizing the choice and dose regimen of proton‐pump inhibitor is essential for treating gastro‐oesophageal reflux disease, and nocturnal acid control is important in preventing complicated gastro‐oesophageal reflux disease.