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Atypical Symptoms of GERD

GERD, or gastroesophageal reflux disease, is a condition that causes stomach acids to flow back into the esophagus. Also called acid reflux, GERD affects people of all ages. The disease is more severe and occurs more frequently than ordinary heartburn. According to the University of Maryland Medical Center, GERD must be diagnosed and treated promptly to prevent serious complications, such as erosive esophagitis, stricture of the esophagus, tooth decay or Barrett's esophagus. Most people with GERD display classic symptoms and can be diagnosed based on symptoms alone. For patients with atypical symptoms, diagnosis can be a long and complicated process.

  1. Significance

    • Typical symptoms of GERD include heartburn and regurgitation of stomach contents, but many people experience atypical symptoms that may delay diagnosis and treatment. Atypical symptoms of GERD include asthma, cough, laryngitis, dental erosions and noncardiac chest pain, according to a review published in the August 15 issue of the American Family Physician. Many people who present with atypical symptoms may lack the more common symptom of heartburn, which sometimes results in a misdiagnosis with asthma or another medical condition.

    Pulmonary Symptoms

    • While a number of pulmonary disorders are associated with GERD, the strongest association seems to be with asthma. Most asthmatics complain of heartburn, and as many as 80 percent of the 15 million Americans diagnosed with asthma may also suffer from GERD, according to a study published in the American Journal of Medicine. GERD may trigger asthma attacks or asthma-like symptoms via indirect stimulation of the distal esophageal sensory vagal nerve. Moreover, many patients with refractory asthma show improvement when treated with acid-suppressive medications. GERD patients may also present with a chronic, unproductive cough. This atypical symptom of GERD may be the only obvious symptom in more than half of patients.

    Ear, Nose and Throat Symptoms

    • According to the University of Maryland Medical Center, GERD may produce symptoms affecting the throat in some people. Persistent hiccups, a chronic sore throat, hoarseness and a feeling of a lump being in the throat are all atypical symptoms of GERD. Some patients also experience dysphagia, or trouble swallowing. In severe cases of dysphagia, food may become lodged in the esophagus, causing choking and severe chest pain. This symptom requires prompt medical attention to rule out serious damage to the esophagus.

    Noncardiac Chest Pain

    • The chest pain experienced by GERD sufferers may mimic heart attack symptoms. There may be a pressure in the chest, with or without burning, and the pain may radiate down the arms or into the neck and jaw. This symptom sends thousands of people to the emergency room every year. To determine if chest pain is caused by GERD or another disorder, such as cardiovascular disease, peptic ulcer, or gallbladder disease, extensive testing may be necessary.

    Diagnosis

    • Anyone with a new onset of ear, nose and throat symptoms, or who complains about recent onset or worsening of asthma or chest pain symptoms should be evaluated for GERD. Diagnosis must be made based on a combination of medical history, symptom presentation and diagnostic tests. Diagnostic tests cannot accurately establish a causal relationship with atypical symptoms. Other tests for GERD include a trial with a medication known as a proton pump inhibitor, a barium esophagram, and an esophagogastroduodenoscopy. According to the International Foundation for Functional Gastrointestinal Disorders, pH monitoring may also be used to measure the frequency of acid reflux episodes experienced.

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