Symptoms of Erosive Esophagitis
Heartburn and regurgitation are the hallmark symptoms of erosive esophagitis, occurring in the majority of patients, though symptom severity does not reliably correlate with the degree of mucosal damage. 1, 2
Primary Symptoms
Typical Esophageal Symptoms:
- Heartburn (substernal burning sensation in the chest) is the most common presenting symptom, often occurring after meals or at night and worsening with stress 1, 3, 2
- Acid regurgitation (sour burping, regurgitation of gastric contents) is the second most frequent complaint 3, 2, 4
- Dysphagia (difficulty swallowing) occurs in approximately 52.6% of patients, typically for solid foods, and may indicate progression to stricture formation 1, 5, 6
- Chest pain (retrosternal pain that can mimic cardiac ischemia, presenting as squeezing or burning) is reported in a significant subset of patients 1, 5, 3, 2
Secondary and Extraesophageal Symptoms
Less Common Esophageal Manifestations:
- Odynophagia (painful swallowing) may occur, particularly when severe erosions or ulcerations are present 6, 2
- Upper abdominal pain is reported in some patients 1, 6
- Food impaction can occur if strictures develop as a complication 6
Extraesophageal Symptoms:
- Chronic cough may be the presenting complaint in some patients 1, 2, 4
- Laryngitis and posterior laryngeal inflammation can manifest as hoarseness or throat clearing 1, 3
- Wheezing and asthma-like symptoms may occur, though the relationship between reflux and respiratory symptoms is complex 1, 2
- Globus sensation (feeling of a lump in the throat) is occasionally reported 1, 3
Critical Clinical Considerations
Symptom-Severity Discordance:
- The severity of symptoms does NOT reliably predict the degree of erosive esophagitis on endoscopy - patients with severe erosions may have minimal symptoms, while those with significant symptoms may have minimal or no visible erosions 1, 2, 7
- Up to 30-70% of patients with reflux symptoms have non-erosive reflux disease (NERD) rather than erosive esophagitis 1, 7
Alarm Symptoms Requiring Urgent Evaluation:
- Dysphagia, odynophagia, unintentional weight loss, or evidence of gastrointestinal bleeding warrant immediate endoscopic evaluation to exclude complications such as strictures, Barrett's esophagus, or malignancy 1, 2
Common Diagnostic Pitfalls
Key Pitfalls to Avoid:
- Assuming symptom severity correlates with disease severity - patients may have Los Angeles Grade C or D esophagitis with minimal symptoms, or severe symptoms with normal endoscopy 1, 2, 7
- Failing to obtain esophageal biopsies during endoscopy - this can miss eosinophilic esophagitis, which can present identically to erosive esophagitis and affects up to 15% of patients with dysphagia 5, 6
- Attributing chest pain to esophageal origin without first excluding cardiac disease - cardiac causes must be ruled out given the substantially higher morbidity and mortality of ischemic heart disease 5
- Overlooking compensatory eating behaviors - patients often unconsciously modify their diet (eating slowly, excessive chewing, avoiding certain foods) which can mask the severity of dysphagia 1, 6