Symptoms of Gastroesophageal Reflux Disease (GERD)
The most common symptoms of GERD include heartburn (a burning discomfort in the retrosternal area) and regurgitation (backflow of stomach contents into the esophagus), which are considered the typical esophageal symptoms with highest specificity for the condition. 1, 2
Typical Symptoms
- Heartburn: Burning sensation in the chest that typically occurs after eating and may worsen when lying down
- Regurgitation: Backflow of stomach contents into the mouth or throat
- Dysphagia: Difficulty or painful swallowing
- Non-cardiac chest pain: Chest pain that mimics cardiac pain but is related to esophageal issues 1, 2
Atypical and Extra-esophageal Symptoms
GERD can present with symptoms beyond the typical esophageal manifestations:
Respiratory symptoms:
Other symptoms:
- Sore throat
- Dental erosions
- Sleep disturbances
- Nausea 2
Important Clinical Considerations
Silent GERD
GERD can be "silent" from a gastrointestinal standpoint in up to 75% of cases, meaning patients may experience extra-esophageal symptoms without the typical heartburn or regurgitation 1, 2. This is particularly common in patients presenting with chronic cough as their primary symptom.
Symptom Severity and Frequency
The prevalence of symptomatic GERD is rising, with more than 30% of US adults reporting at least weekly symptoms 1. Symptoms can range from mild to severe and can significantly impact quality of life.
Warning Signs
Certain symptoms warrant immediate medical attention as they may indicate complications:
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- GI bleeding (hematemesis or melena)
- Unexplained weight loss
- Persistent vomiting
- Iron deficiency anemia 1
Factors That May Worsen Symptoms
- Dietary triggers: Fatty foods, spicy foods, citrus, tomatoes, chocolate, coffee, carbonated beverages 3
- Lifestyle factors:
- Obesity
- Smoking
- Alcohol consumption
- Eating large meals
- Eating close to bedtime
- Certain physical activities, especially postprandial 3
Complications of GERD
If left untreated, GERD can lead to serious complications:
- Erosive esophagitis
- Esophageal strictures
- Barrett's esophagus (precancerous condition)
- Esophageal adenocarcinoma 1, 2
Diagnostic Approach
While the diagnosis of GERD is often made based on typical symptoms, objective testing may be necessary in certain situations:
- Persistent symptoms despite empiric therapy
- Presence of alarm symptoms
- Isolated extra-esophageal symptoms
- Patients meeting criteria for Barrett's esophagus screening 1
The recognition of GERD symptoms is crucial for timely diagnosis and management to prevent complications and improve quality of life. Patients with typical symptoms can often be diagnosed clinically, while those with atypical presentations may require additional testing to confirm the diagnosis.