Clinical Differences Between GERD and Gastritis
GERD and gastritis are fundamentally different conditions affecting different anatomical locations with distinct pathophysiologic mechanisms: GERD involves reflux of gastric contents into the esophagus causing esophageal symptoms and/or tissue damage, while gastritis refers to inflammation of the gastric mucosa itself.
Anatomical Location and Pathophysiology
GERD is defined as a condition that develops when reflux of stomach contents into the esophagus causes troublesome symptoms and/or complications 1. The disease results from backflow of gastric contents across the lower esophageal sphincter into the esophagus 1.
Gastritis, in contrast, represents inflammation of the stomach lining itself and does not inherently involve the esophagus 2. Interestingly, chronic gastritis may actually be protective against GERD development (OR 0.7,95% CI 0.5-0.9) 2.
Clinical Presentation Patterns
GERD Typical Symptoms:
- Heartburn: Burning discomfort in the retrosternal area moving upward toward the throat, occurring in approximately 89% of gastroenterology patients with GERD 3
- Acid regurgitation: Backflow of gastric contents into the esophagus or mouth 3
- Dysphagia: Difficulty swallowing, particularly concerning when present as it may indicate complications like strictures or malignancy 4
- Typical symptoms are approximately 70% sensitive and specific for objective GERD 3
GERD Atypical/Extraesophageal Manifestations:
- Silent GERD: Can be completely asymptomatic from a gastrointestinal standpoint in up to 75% of patients when presenting with chronic cough 1, 3
- Chronic cough: Accounts for 5-41% of chronic cough cases in adults 3
- Hoarseness: Present in 100% of otolaryngology patients with laryngopharyngeal reflux, yet only 6% report heartburn 3
- Chest pain, particularly noncardiac chest pain with proximal acid extension 5
Gastritis Symptoms:
Gastritis typically presents with:
- Epigastric pain or discomfort 6
- Nausea and vomiting
- Upper abdominal tenderness
- Symptoms are localized to the stomach rather than retrosternal or involving regurgitation
Key Diagnostic Distinctions
Symptom Location:
- GERD: Retrosternal burning that moves upward, regurgitation into throat/mouth 3
- Gastritis: Epigastric pain localized to upper abdomen 6
Temporal Patterns:
- GERD: Symptoms typically occur during meals and postprandial state, often worse when recumbent 3
- Gastritis: May be related to meals but doesn't characteristically worsen with position changes
Response to Acid Suppression:
- GERD: Typically responds well to proton pump inhibitor therapy, providing diagnostic utility 3, 7
- Gastritis: May respond to acid suppression but response pattern differs based on etiology (H. pylori, NSAID-induced, etc.)
Important Clinical Pitfalls
Do not assume all upper GI symptoms are GERD: Only 18% of patients referred for endoscopy due to heartburn/regurgitation actually have GERD 2. The positive predictive value of heartburn and regurgitation for endoscopy-positive GERD is only 0.37 2.
Recognize that gastritis and GERD have an inverse relationship: Chronic gastritis appears protective against GERD development, while H. pylori infection (which causes gastritis) shows significantly lower prevalence in GERD patients (31%) compared to controls (61%, p < 0.001) 8.
GERD can present without any GI symptoms: Up to 75% of patients with GERD-related chronic cough have no gastrointestinal complaints 1, making the diagnosis challenging when clinicians focus only on typical symptoms.
Endoscopic and Histologic Differences
- GERD: May show erosive esophagitis, Barrett's esophagus, esophageal strictures, or be endoscopically normal (endoscopy-negative GERD in 33% of cases, rising to 85% in patients <50 years) 2
- Gastritis: Shows gastric mucosal inflammation, erythema, erosions on endoscopy with histologic confirmation of inflammatory infiltrate in gastric mucosa 2, 8
Risk Factor Profiles
GERD Risk Factors:
- Male sex (OR 1.9) 2
- NSAID use (OR 2.0) 2
- Obesity 3
- Previous medication for upper GI symptoms (OR 2.7) 2
Gastritis Risk Factors:
- H. pylori infection
- NSAID use
- Alcohol consumption
- Autoimmune conditions
The fundamental distinction is anatomical and pathophysiologic: GERD is an esophageal disease caused by reflux, while gastritis is gastric mucosal inflammation—they can coexist but represent separate disease processes requiring different diagnostic and therapeutic approaches.