Symptoms of Gastroesophageal Reflux Disease (GERD)
Typical Symptoms
The hallmark symptoms of GERD are heartburn and regurgitation, which have the highest specificity for diagnosis and allow clinical diagnosis without objective testing. 1, 2
- Heartburn is described as a retrosternal burning sensation that rises toward the throat 3
- Regurgitation refers to the effortless return of gastric contents into the mouth, distinct from water brash 3, 2
- These two symptoms are present in approximately 89% of gastroenterology patients with GERD 2
- Acid regurgitation occurs in 72.6% of patients with reflux disease 3
Atypical and Extraesophageal Symptoms
GERD can present without any gastrointestinal symptoms in up to 75% of patients with extraesophageal manifestations, making diagnosis challenging. 3, 2
Respiratory Manifestations
- Chronic cough is a common extraesophageal presentation 3, 4, 5
- Asthma and bronchospasm may be triggered by reflux 4, 5
- Laryngitis and hoarseness, though hoarseness was present in 100% of otolaryngology patients with reflux but 0% of gastroenterology patients with GERD 3, 6
Other Atypical Symptoms
- Chronic sore throat without typical reflux symptoms 5
- Noncardiac chest pain that mimics cardiac disease 7, 5
- Dental erosions from chronic acid exposure 5
- Dysphagia (difficulty swallowing) 3
- Epigastric pain (50.0% prevalence), retrosternal pain (47.1%), retrosternal tightness (33.2%), and nausea (36.5%) 3
Alarm Features Requiring Urgent Evaluation
Dysphagia requires urgent upper endoscopy to exclude malignancy, stricture, or eosinophilic esophagitis. 2
- Gastrointestinal bleeding, hematemesis, or hematochezia necessitate immediate endoscopic evaluation 2
- Unintentional weight loss is a warning sign requiring endoscopy to rule out esophageal adenocarcinoma 2
Important Clinical Considerations
Symptom Variability
- Both frequency and severity of symptoms should be assessed, as they may vary independently 3
- Patients with no or mild heartburn can still have moderate or severe regurgitation (5% in primary care, 16% in specialist settings) 3
- Different reflux-related symptoms may respond differently to therapy 3
Common Diagnostic Pitfalls
- Do not assume all extraesophageal symptoms are due to GERD without proper testing, as the presence or absence of typical GI symptoms cannot rule in or rule out GERD as the cause 3, 2
- Approximately one-third of the population experiences occasional heartburn without having GERD as a disease, so symptom presence alone does not confirm pathologic reflux 3, 2
- The spectrum of GERD manifestations varies by specialty: heartburn predominates in gastroenterology patients while extraesophageal symptoms predominate in otolaryngology and pulmonology patients 3