The symptoms of gastroesophageal reflux disease (GERD), the condition in which refluxed gastric contents cause troublesome symptoms or injury to the esophagus, arise mainly from the esophagus and sometimes from structures above it.
Typical and less common symptoms
Heartburn and regurgitation are the main clinical manifestations of GERD. Chest pain and dysphagia (difficulty swallowing) are less common. The mechanism behind these symptoms is much more complicated than simple erosion of the mucosa: activation of afferent sensory nerves and visceral sensitivity also contribute, which is why symptom severity does not always match the visible injury.
Patients who have the less common symptoms, such as dysphagia and chest pain, undergo further evaluation, because these symptoms can indicate an alternative diagnosis, such as a cardiovascular disorder, or a more complicated case of GERD, such as a peptic stricture (a narrowing of the esophagus) or esophageal adenocarcinoma.
Extra-esophageal symptoms and associated disorders
Reflux can also produce symptoms beyond the esophagus. Laryngitis, chronic cough, asthma and dental erosion are recognised extra-esophageal symptoms of GERD.
Separately, a further group of disorders is associated with GERD but is not counted among its symptoms: pharyngitis, chronic bronchitis, pulmonary fibrosis, chronic sinusitis, sleep apnea and cardiac arrhythmia. These are associations, not causal relationships, so their presence does not by itself show that reflux is the cause.
Differential diagnosis
Because the clinical manifestations of GERD are not specific, the differential diagnosis is broad. It includes infectious and pill-induced esophagitis, eosinophilic esophagitis, peptic ulcer disease (PUD), dyspepsia, biliary colic, esophageal motility disorders, and coronary artery disease, which should be addressed first. Telling these apart from reflux, and finding what reflux has already damaged, depends on knowing both the injuries chronic reflux causes and the tests that reveal them.