What are the common symptoms of Gastroesophageal Reflux Disease (GERD)?

Common Symptoms of GERD

The most common symptoms of Gastroesophageal Reflux Disease (GERD) include heartburn (a substernal burning sensation in the chest), regurgitation, and dysphagia, with heartburn being experienced by up to 44% of adults in the United States at least once monthly. 1

Primary Symptoms in Adults

GERD manifests differently across age groups, with distinct symptom patterns:

Classic Symptoms

• Heartburn: Burning discomfort in the retroesternal area that may radiate upward toward the throat 1, 2
• Regurgitation: Backflow of stomach contents into the mouth 1, 2
• Dysphagia: Difficulty swallowing 2

Frequency of Symptoms

• 44% of US adults experience heartburn at least once monthly 1
• 18% experience heartburn at least weekly 1
• 15% of control subjects in studies report reflux symptoms weekly 1

Atypical Manifestations

Importantly, 20-60% of GERD patients present with atypical symptoms without experiencing the classic heartburn sensation 2. These extraesophageal manifestations include:

Respiratory Symptoms

• Chronic cough: GERD can cause chronic cough without any GI symptoms in up to 75% of cases 1
• Asthma: GERD can contribute to or exacerbate asthma symptoms 3

Otolaryngologic Symptoms

• Hoarseness 1, 3
• Sore throat 1

Other Atypical Presentations

• Non-cardiac chest pain 3
• Sleep disturbances
• Dental erosions

Symptoms in Children

Pediatric GERD presents differently based on age 1:

Infants (under 1 year)

• Regurgitation or vomiting with irritability
• Feeding refusal or anorexia
• Poor weight gain
• Dysphagia (painful swallowing)
• Arching of the back during feedings

Children and Adolescents

• More adult-like symptoms emerge in older children
• Adolescents often present with heartburn typical of adults 1

Symptom Severity and Complications

The severity of GERD symptoms varies widely, and prolonged, untreated GERD can lead to complications:

• Erosive esophagitis 1
• Esophageal strictures 1
• Barrett's esophagus: A metaplastic change in the esophageal lining that increases risk for esophageal adenocarcinoma 1

Risk Factors for Symptom Exacerbation

Several lifestyle factors can trigger or worsen GERD symptoms 4:

• Dietary triggers: Fatty, fried, spicy foods, citrus juices, tomatoes, chocolate, coffee/tea, carbonated beverages
• Eating habits: Large meals, eating shortly before bedtime, irregular meal patterns
• Lifestyle factors: Obesity, moderate/high alcohol consumption, smoking, certain types of physical activity

Clinical Pearls

• GERD symptoms can be silent from a GI standpoint in up to 75% of cases when causing chronic cough 1
• The correlation between reflux symptoms and actual esophageal acid exposure is only moderate 1
• Symptoms tend to be more severe in patients with complications such as erosive esophagitis, strictures, or Barrett's esophagus 1
• GERD prevalence varies geographically, with lower rates in Eastern Asia (8.5%) compared to Western Europe and North America (10-20%) 1

Understanding the diverse presentation of GERD symptoms is crucial for early diagnosis and appropriate management to prevent complications and improve quality of life.