For Patients & General Readers
Gastroesophageal Reflux Disease (GERD) is a common condition where stomach acid flows back up into the esophagus, the tube connecting your mouth to your stomach. This can cause a burning sensation in your chest, known as heartburn, and other uncomfortable symptoms. If left untreated, GERD can lead to more serious complications.
Clinical Overview
GERD is a chronic condition characterized by the abnormal reflux of gastric contents into the esophagus, leading to symptoms and/or tissue damage. It results from a complex interplay of factors including impaired lower esophageal sphincter (LES) function, reduced esophageal clearance, and gastric factors.
Clinical Presentation
- Typical symptoms include heartburn and regurgitation.
- Atypical symptoms can include chest pain, dysphagia, odynophagia, chronic cough, hoarseness, and asthma exacerbations.
- Symptoms are often exacerbated after meals, when lying down, or bending over.
- Physical examination is often unremarkable in uncomplicated GERD.
- Long-standing GERD can lead to complications such as esophagitis, peptic strictures, and Barrett's esophagus.
Signs & Symptoms
Symptoms (Patient-Reported)
- Heartburn (a burning sensation in the chest, often after eating or at night)
- Regurgitation (sour or bitter fluid backing up into the throat or mouth)
- Difficulty swallowing (dysphagia)
- Painful swallowing (odynophagia)
- Sensation of a lump in the throat (globus sensation)
- Chronic cough
- Hoarseness or sore throat
- Chest pain (can mimic cardiac pain)
Signs (Clinician-Observed)
- Erosions or inflammation of the esophageal mucosa on endoscopy.
- Evidence of peptic stricture formation.
- Intestinal metaplasia (Barrett's esophagus) on biopsy.
- Dental enamel erosion (less common but can be seen with chronic, severe reflux).
Differential Diagnoses
| Condition | Distinguishing Feature |
|---|
| Peptic Ulcer Disease | Epigastric pain, often relieved by food or antacids, rather than chest burning. Endoscopy is key for diagnosis. |
| Coronary Artery Disease (CAD) | Chest pain that is typically exertional, radiating to the arm or jaw, and associated with shortness of breath. ECG and cardiac markers are crucial. |
| Achalasia | Progressive dysphagia to both solids and liquids, often with regurgitation of undigested food. Esophageal manometry is diagnostic. |
| Eosinophilic Esophagitis (EoE) | Dysphagia, food impaction, and abdominal pain. Diagnosis requires esophageal biopsy showing eosinophilic infiltration. |
| Functional Heartburn | Heartburn symptoms without objective evidence of reflux or esophageal abnormality on investigation. Diagnosis of exclusion. |
| Biliary Colic | Right upper quadrant or epigastric pain, often postprandial and radiating to the back. Ultrasound is diagnostic. |
Red Flags — Seek Immediate Care
- Unexplained weight loss
- Persistent vomiting
- Significant dysphagia or odynophagia
- Hematemesis or melena
- Anemia
- Alarm symptoms in patients over 50 years old
Key Investigations
- Empirical trial of proton pump inhibitors (PPIs).
- Upper endoscopy (EGD) to assess for esophagitis, strictures, and Barrett's esophagus.
- 24-hour esophageal pH monitoring (especially if PPI trial is unsuccessful or diagnosis is uncertain).
- Esophageal manometry to assess LES function and esophageal motility.
- Barium swallow (less common for initial GERD diagnosis, more for structural abnormalities).
Management Overview
Management focuses on lifestyle modifications, pharmacotherapy with acid suppressants (PPIs or H2 blockers), and in select cases, surgical intervention. Treatment aims to reduce symptom burden, heal esophageal lesions, and prevent complications.
Disclaimer: This article is for educational purposes only and does not constitute medical advice.
Always consult a qualified healthcare professional for diagnosis and treatment.
TruelyserMD does not replace clinical judgement.