The following symptoms and complaints may indicate gastroesophageal reflux disease (GERD) (reflux symptoms):
Leading symptoms
- Heartburn
- Regurgitation of stomach contents (backflow of food pulp from the esophagus into the mouth)
- Acid or non-acid regurgitation
Complaints often occur when lying down. Accompanying symptoms
- Burning in the throat; possibly also the tongue* .
- Irritative cough/chronic cough*
- Earache*
- Dysphagia (swallowing disorder)
- Odynophagia (pain on swallowing, rare).
- Feeling of nasal congestion (nasal congestion)* .
- Globus sensation (“feeling of having a lump in the throat”/lump sensation)*
- Frequent clearing of the throat/forced clearing of the throat* (bes. in the morning).
- Morning hoarseness* (dysphonia due to laryngitis gastrica).
- Busy voice*
- Frequent sore throat
- Bad breath* (halitosis, foetor ex ore)
- Upper abdominal pain (epigastric pain).
- Stridor (Latin, plural stridores, literally “hissing”, “whistling”) – abnormal breathing sounds due to narrowing of the airways.
- Thoracic pain (chest pain/chest wall pain) or retrosternal pressure/pain (about 30% of cases; DD ischemic heart disease):
- Reflux thoracic pain syndrome: core symptom is isolated (noncardiac) thoracic pain; clinical presentation may mimic coronary artery disease (CAD)
* Typical symptoms of laryngopharyngeal reflux (LPR).
Further notes
- Many patients who have gastroesophageal reflux disease are asymptomatic and do not seek medical attention until complications arise.
- In children (< 8-12 years), symptom description is unreliable!
- In laryngopharyngeal reflux (LPR), the “silent reflux”, the cardinal symptoms of gastroesophageal reflux, such as heartburn and regurgitation (backflow of food pulp from the esophagus into the mouth) are absent. Furthermore, LPR promotes diseases such as bronchial asthma (reflux asthma), rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses (“sinusitis“)), and recurrent tympanic effusions in children. Note: problems with expiration (breathing out) are a typical sign of “normal” asthma, while problems with inspiration (breathing in) are more indicative of silent reflux.
Gender differences (gender medicine)
- Men are more likely to suffer from the erosive course of gastroesophageal reflux disease. The development of GERD-associated complications, such as Barrett’s esophagus and adenocarcinoma of the esophagus (food pipe), is higher in men than in women.
- Women are more likely to suffer from nonosseous reflux disease.
Warning signs (red flags) and risk factors*
- Family history of upper digestive tract malignancies.
- Involuntary weight loss (>5%).
- Dysphagia (difficulty swallowing) → think of: Esophageal cancer (cancer of the esophagus).
- Odynophagia (pain on swallowing).
- Long-standing (severe, esp. also nocturnal) symptoms: Barrett’s lesion?
- Clinical or apparative evidence of esophageal/epigastric space-occupying lesion, stricture, or an ulcer.
- Anemia (esp. for evidence of gastrointestinal bleeding).
* In all cases, immediate esophago-gastro-duodenoscopy (ÖGD) is required!
