Acid Reflux (GERD) and the Esophagus
Heartburn. Heartburn is the primary symptom of GERD. It is a burning sensation that spreads up from the stomach to the chest and throat. Heartburn is most likely to occur in connection with the following activities:
- Eating a heavy meal
- Bending over
- Lying down, particularly on the back
Patients with nighttime GERD, a common problem, tend to feel more severe pain than those whose symptoms occur at other times of the day.
The severity of heartburn does not necessarily indicate actual injury to the esophagus. For example, Barrett's esophagus, which causes precancerous changes in the esophagus, may only trigger a few symptoms, especially in elderly people. On the other hand, people can have severe heartburn but suffer no damage in their esophagus.
Dyspepsia. Up to half of GERD patients have dyspepsia, a syndrome that consists of the following:
- Pain and discomfort in the upper abdomen
- A feeling of fullness in the stomach
- Nausea after eating
People without GERD can also have dyspepsia.
Regurgitation. Regurgitation is the feeling of acid backing up in the throat. Sometimes acid regurgitates as far as the mouth and can be experienced as a "wet burp." Uncommonly, it may come out forcefully as vomit.
Less Common Symptoms
Many patients with GERD do not have heartburn or regurgitation. Elderly patients with GERD often have less typical symptoms than do younger people. Instead, symptoms may occur in the mouth or lungs.
Chest Sensations or Pain. Patients may have the sensation that food is trapped behind the breastbone. Chest pain is a common symptom of GERD. It is very important to differentiate it from chest pain caused by heart conditions, such as angina and heart attack.
Symptoms in the Throat. Less commonly, GERD may produce symptoms that occur in the throat:
- Acid laryngitis. A condition that includes hoarseness, dry cough, the sensation of having a lump in the throat, and the need to repeatedly clear the throat.
- Trouble swallowing (dysphagia). In severe cases, patients may choke or food may become trapped in the esophagus, causing severe chest pain. This may indicate a temporary spasm that narrows the tube, or it could indicate serious esophageal damage or abnormalities.
- Chronic sore throat
- Persistent hiccups
Coughing and Respiratory Symptoms. Airway symptoms, such as coughing and wheezing, may occur.
Chronic Nausea and Vomiting. Nausea that persists for weeks or even months, and is not traced back to a common cause of stomach upset, may be a symptom of acid reflux. In rare cases, vomiting can occur as often as once a day. All other causes of chronic nausea and vomiting should be ruled out, including ulcers, stomach cancer, obstruction, and pancreas or gallbladder disorders.
Gastroesophageal Reflux Disease in Children
GERD is very common in children of all ages, but it is usually mild. Symptoms usually get better in most infants by age 12 months, and in nearly all children by 24 months. Children with the following conditions are at higher risk for severe GERD:
- Neurological impairments
- Food allergies
- Cyclic vomiting
- Cystic fibrosis
- Problems in the lungs, ear, nose, or throat
- Any medical condition affecting the digestive tract
Symptoms in Children. Typical symptoms in infants include frequent regurgitation, irritability, arching the back, choking or gagging, and resisting feedings.
A physician should examine any child who has symptoms of severe GERD as soon as possible, because these symptoms may indicate complications such as anemia, failure to gain weight, or respiratory problems. Symptoms of severe GERD in infants and small children may include:
- Failure to thrive
- Chronic coughing
- Frequent infections
- Gasping or frequently stopping breathing while asleep (a condition called sleep apnea)
- Severe vomiting -- particularly if it is green colored (bilious) -- always requires a doctor's visit, because it could be a symptom of a severe obstruction.
Babies and children may experience these symptoms without having GERD. Many infants with normal irritability are being inappropriately treated for reflux disorders.