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

Symptoms of Gastroesophageal Reflux Disease (GERD)

GERD presents with a spectrum of typical esophageal symptoms including heartburn and regurgitation as the most common manifestations, along with various extraesophageal symptoms that can occur with or without the typical symptoms. 1

Typical Esophageal Symptoms

Primary Symptoms

• Heartburn: Burning discomfort in the retrosternal area that may move upward toward the throat 2, 3
• Regurgitation: The sensation of stomach contents flowing back into the throat or mouth 2, 1

Other Esophageal Symptoms

• Dysphagia: Difficulty swallowing 4
• Non-cardiac chest pain: Chest discomfort not related to cardiac conditions 2, 1
• Epigastric pain: Pain in the upper central region of the abdomen 2
• Retrosternal pain or tightness: Discomfort behind the breastbone 2

Extraesophageal (Atypical) Symptoms

GERD can present with extraesophageal manifestations, sometimes without any typical esophageal symptoms, making diagnosis challenging:

• Respiratory symptoms:

  • Chronic cough 2, 1
  • Asthma exacerbations 1, 5
  • Hoarseness 1, 5
  • Dysphonia (voice disturbances) 2, 1

• Otolaryngologic symptoms:

  • Sore throat 1
  • Throat clearing 1
  • Globus sensation (feeling of a lump in the throat) 1
  • Excess mucus production 1
  • Post-nasal drip 1

• Other manifestations:

  • Dental erosions 1, 5
  • Nausea 2, 3

Symptom Characteristics

The severity and frequency of symptoms are both important clinical considerations:

• Frequency: More than one episode of mild heartburn per week is considered unacceptable to most patients 2
• Severity: Can range from mild to severe, with nocturnal symptoms (such as heartburn with choking) often being particularly troublesome 2
• Timing: Symptoms may worsen after meals, when lying down, or at night 6

Clinical Significance

It's important to note that symptom severity doesn't always correlate with the presence or severity of esophageal damage:

• Up to 50% of patients with GERD symptoms do not have visible esophageal lesions on endoscopy (non-erosive reflux disease) 7
• Conversely, some patients with severe esophagitis may report minimal symptoms 4

Warning Signs Requiring Immediate Attention

Certain symptoms warrant immediate medical attention as they may indicate complications:

• Dysphagia (difficulty swallowing)
• Odynophagia (painful swallowing)
• GI bleeding
• Unexplained weight loss
• Persistent vomiting
• Iron deficiency anemia 1

Diagnostic Challenges

The diagnosis of GERD based on symptoms alone can be challenging because:

1. Symptoms may overlap with other conditions such as functional heartburn, eosinophilic esophagitis, or motility disorders 7
2. Up to 75% of patients with extraesophageal reflux symptoms may not experience typical heartburn or regurgitation ("silent reflux") 2
3. Symptom response to empiric PPI therapy is not always reliable for diagnosis, with up to 50% of patients having inadequate symptom relief 2, 7

Understanding the full spectrum of GERD symptoms is essential for proper diagnosis and management, especially in cases presenting with atypical manifestations.