Can Gastroesophageal Reflux Disease (GERD) cause severe retrosternal burning or pain and breathlessness while walking?

Symptoms of GERD and Its Relationship to Retrosternal Pain and Breathlessness

Yes, GERD can cause severe retrosternal burning or pain and breathlessness while walking, as these are recognized manifestations of gastroesophageal reflux disease that can mimic cardiac symptoms. 1

Common Symptoms of GERD

GERD presents with a spectrum of symptoms, both typical and atypical:

Typical Symptoms

• Heartburn (burning sensation in the retrosternal area that may rise toward the throat) 1, 2
• Regurgitation (backflow of gastric contents into the esophagus or oral cavity) 1, 2
• Dysphagia (difficulty swallowing) 1

Atypical/Extraesophageal Symptoms

• Chest pain that can mimic cardiac ischemia 1
• Respiratory symptoms including breathlessness 1, 3
• Throat symptoms (hoarseness, sore throat) 4
• Nausea 1
• Epigastric pain 1
• Retrosternal tightness 1

GERD and Chest Pain

GERD is a significant cause of non-cardiac chest pain:

• Approximately 30-50% of patients with recurrent non-cardiac chest pain have GERD as the underlying cause 1
• GERD-related chest pain can be indistinguishable from ischemic cardiac pain 1
• The pain may be described as squeezing or burning, similar to angina 1
• Duration can range from minutes to hours 1

GERD and Respiratory Symptoms

GERD can cause or exacerbate respiratory symptoms including:

• Breathlessness/dyspnea 1, 3
• Asthma exacerbations 1, 3
• Chronic cough 1

Mechanism of GERD-Related Chest Pain and Breathlessness

• Chest pain from GERD results from stimulation of chemoreceptors by acid or hyperosmolar substances, mechanoreceptors by abnormal contraction or distention, or thermoreceptors 1
• Reflux episodes can trigger bronchospasm and respiratory symptoms through direct aspiration or vagally-mediated reflexes 1
• Pain can worsen with physical activity like walking due to increased intra-abdominal pressure 1

Distinguishing Features of GERD-Related Symptoms

• Often occurs after meals or at night 1
• May worsen with stress 1
• Can resolve spontaneously or with antacids 1
• May be associated with positional changes (worse when lying down) 1
• Can be triggered by certain foods, alcohol, or large meals 1

Important Clinical Considerations

• Cardiac causes must be carefully ruled out before attributing chest pain to GERD 1
• GERD-related chest pain may respond to a trial of twice-daily PPI therapy 1
• Symptoms that merit early evaluation (within 2 weeks) include dysphagia, odynophagia, GI bleeding, unexplained iron deficiency anemia, weight loss, and recurrent vomiting 1
• The presence of warning signs such as weight loss, bleeding, or anemia should prompt further investigation 1

Diagnostic Approach

When GERD is suspected as a cause of chest pain and breathlessness:

• Rule out cardiac and pulmonary causes first 1
• Consider a trial of empiric acid suppression therapy in patients without alarm symptoms 1
• If symptoms persist despite acid suppression, consider upper endoscopy 1
• For persistent symptoms with normal endoscopy, esophageal function testing and pH monitoring may be needed 1

GERD is a common condition affecting 10-20% of the population in Western countries, and its symptoms can significantly impact quality of life 1, 2. Recognition of both typical and atypical manifestations is crucial for proper diagnosis and management.