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

Complete Symptom Profile of Gastroesophageal Reflux Disease (GERD)

GERD presents with a broad spectrum of symptoms that extend far beyond classic heartburn, encompassing both esophageal and extraesophageal manifestations that vary significantly by age and can occur with or without typical gastrointestinal complaints. 1

Typical Esophageal Symptoms

The classic presentation includes:

• Heartburn - the most common symptom, though not 100% specific for GERD 1
• Acid regurgitation - backflow of stomach contents into the mouth 1
• Dysphagia - difficulty swallowing 1

These typical symptoms occur in approximately 30% of US adults at least weekly, with 59% experiencing occasional episodes 1

Atypical Esophageal Symptoms

• Non-cardiac chest pain - can mimic cardiac disease 1
• Odynophagia - painful swallowing 1

Extraesophageal (Atypical) Manifestations

Critically, GERD can be "silent" from a gastrointestinal standpoint in up to 75% of cases presenting with extraesophageal symptoms, meaning patients may have no heartburn or regurgitation whatsoever. 1, 2

Respiratory Symptoms

• Chronic cough - contributing factor in 5-41% of chronic cough cases 1, 2
• Asthma or asthma-like symptoms 1, 3
• Wheezing 4
• Recurrent pneumonia 3
• Chronic bronchitis 1, 3
• Bronchiectasis 2

Otolaryngologic Symptoms

• Hoarseness - present in 100% of otolaryngology patients with laryngopharyngeal reflux 1
• Dysphonia (voice changes) 1
• Sore throat 1
• Globus sensation (lump in throat feeling) 1
• Chronic throat clearing 5
• Recurrent sinusitis 5
• Otitis media 3

Oral/Dental Symptoms

• Atypical loss of dental enamel 3
• Burning sensation on the tongue 5

Age-Specific Presentations

Infants (Under 1 Year)

• Regurgitation or vomiting with irritability 1
• Anorexia or feeding refusal 1
• Poor weight gain 1
• Arching of the back during feedings 1
• Presumably painful swallowing 1

Peak incidence occurs at 4 months of age (50%), declining to 5-10% by 12 months 1

Children (1-11 Years)

Treatment studies show 85% had mild to moderate overall GERD symptoms at baseline, with both erosive and non-erosive presentations 6

Adolescents (12-17 Years)

Present similarly to adults, with 89% having mild to moderate symptoms and heartburn being more reliably diagnostic 6

Important Clinical Patterns

Positional worsening - symptoms that worsen when lying down or at nighttime are characteristic 7, 2

Meal-related exacerbation - cough or other symptoms worsening with or after meals 7, 2

Variable presentation by specialty - heartburn present in 89% of gastroenterology patients but only 6% of otolaryngology patients with GERD, while hoarseness shows the opposite pattern 1

Complications and Associated Conditions

• Esophagitis 1
• Stricture 1
• Barrett's esophagus 1
• Esophageal adenocarcinoma 1
• Chemical pneumonitis 2
• Idiopathic pulmonary fibrosis 3

Critical Diagnostic Pitfall

The absence of heartburn or regurgitation does NOT exclude GERD, particularly when evaluating extraesophageal symptoms. Up to 75% of patients with reflux-related chronic cough have no typical GI symptoms, making diagnosis challenging and requiring objective testing rather than relying on symptom profile alone 1, 2, 8