Symptoms of GERD
Symptoms of GERD are numerous and they can be quite diverse. The clinical picture of GERD can encompass typical (esophageal) and atypical (extraesophageal) symptoms. This is caused by the stage of the disease, complications caused by GERD and other diseases of the gastrointestinal tract.
Typical (esophageal) symptoms of GERD
- Heartburn, which gets worse when lying down, stooping or bending over or eating. During heartburn the content of the stomach enters the esophagus. Heartburn can be exacerbated by eating certain types of food, drinking alcohol and soft drinks, lifting weights, and lying down after a meal;
- Burping (release of gas from the stomach) – gets worse after a meal or after drinking carbonated beverages;
- Regurgitation (bringing food back up) – the content of the stomach goes beyond the esophagus and reaches the mouth cavity. People often notice it as an acidic taste at the back of their tongue. This symptom gets worse after physical activity right after a meal;
- Feeling of discomfort behind your breastbone and epigastric pain – are caused by the irritation of the mucous layer of esophagus by the stomach acid;
- Chest pain which irradiates into the interscapular region, neck, lower jaw, and left part of the thorax. Oftentimes people mistake this type of heartburn with ischemic heart disease. It can be easily distinguished from ischemic heart disease by taking antacids;
- Nausea and increased salivation – are the non-specific reaction of the body to the inflammation in the esophagus or stomach;
- Dysphagia (having hard time swallowing) and pain when the food goes down the esophagus – these symptoms usually occur due to esophagitis (the inflammation of the mucous layer of the esophagus).
Atypical (extraesophageal) symptoms of GERD
Sometimes GERD can be masquerade as a whole range of other conditions that affect extraesophageal structures leading to:
- Pulmonary presentations – occur either due to microaspiration of the stomach acid into the lungs, or because of the irritation of the tracheobronchial tree through the wall of the esophagus. This leads to bronchial obstruction with hyper-viscous mucus, which causes relentless coughing. Currently it is believed that GERD can trigger asthma attacks. GERD is often present when the patient is suffering from asthma attacks that usually happen at night;
- Cardiac presentations – during GERD are very similar to those felt as a result of angina pectoris. In contrast to angina pectoris, this pain appears after overeating, eating acidic or spicy food;
- Otolaryngologic presentations – occur due to constant irritation of the throat and nose by the stomach acid. They include hoarseness, chronic laryngitis, chronic cough, vocal cord ulcers and granulomas, globus sensation, laryngeal and tracheal stenosis, mouth soreness, laryngeal cancer, halitosis, mouth soreness, otalgia, pharyngitis, chronic sinusitis, stridor, croup, and dysphonia;
- Stomatologic presentations – result from the corrosive influence of the stomach acid on the teeth and oral cavity, which includes mouth soreness and dental erosions.
GERD may also injure the esophagus resulting in
- Reflux esophagitis – is the inflammation of the mucous layer of the esophagus which leads to ulcerations on the junction between the esophagus and stomach;
- Esophageal strictures – an inflammation of the esophagus caused by the stomach acid can lead to the narrowing of the esophagus;
- Barrett’s esophagus – due to constant irritation of the mucous layer of the esophagus by the stomach acid, some of the cells undergo intestinal metaplasia (usually in the distal part of the esophagus). Intestinal metaplasia is when stratified squamous epithelium of the esophagus is changed to goblet cells, which are usually found in the distal parts of the gastrointestinal tract;
- Esophageal adenocarcinoma – is a form of cancer that happens as a result of Barrett’s esophagus. This type of cancer leads to pain, dysphagia and a number of other symptoms. Small tumors can be treated surgically; larger tumors, however, are usually not operable. Prognosis is determined by the extent size of the tumor; however, it is usually fairly poor.