Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when the stomach acid flows back into the esophagus and enters the mouth. This happens when the lower esophageal sphincter (LES) relaxes or weakens.
The LES is a valve-like muscle that separates the throat and stomach. When it functions as required, this muscle relaxes to allow food to pass through the esophagus and closes once the food has reached the stomach. A relaxed or faulty lower esophageal sphincter remains open, and this allows acids to creep back into the throat.
It is estimated that GERD affects around 10 to 30% of the population in developed countries, including 20% of Americans. This condition is associated with various typical and atypical signs and symptoms that can affect the quality of life of the patient. Patients with GERD can manifest typical symptoms such as heartburn, dysphagia, and regurgitation as well as atypical symptoms like hoarseness, chest pain, asthma, and aspiration.
These symptoms often occur when one is bending over, eating a heavy meal, lifting an object, or just lying down on their back. Some of the common symptoms of gastroesophageal reflux disease are as follows:
Heartburn, also known as acid reflux or acid indigestion, is the most common symptom of gastroesophageal reflux disease (GERD). This condition is brought about when contents in the stomach flow back into the pipe that transports food from the mouth to the stomach, likewise known as the esophagus.
When this happens, you will experience a burning sensation behind the breastbone which then moves to the chest or throat. The burning pain from stomach acid usually occurs after eating, and it may worsen at night. It can also aggravate as you bend over or lie down.
According to the American College of Gastroenterology, it is estimated that at least 15 million Americans suffer from heartburn each day. While occasional heartburn is considered normal, recurrent heartburn can be a sign that one is suffering from GERD. It is reported that a high number of GERD patients experience heartburn symptoms.
You might have GERD if you get heartburns twice or more times in a week or if it occurs at night and interferes with your sleep. Recurrent heartburn is, therefore, a cause of concern and is likely to indicate that there are other underlying health issues.
2. Regurgitation of Food
Patients who have gastroesophageal reflux disease also reported experiencing regurgitation. Regurgitation is usually described as the tendency of food or sour fluid to move up and down in the chest. The acid flows back to the mouth, thereby causing a sour taste and a burning sensation. This symptom is triggered when the stomach is compressed due to exercising and bending over after a meal. It can also occur after eating large meals.
The frequency of regurgitation on GERD patients usually varies with some patients complaining of having this symptom daily while others experience it around 2 to 3 days or 4 to 6 days every week. In a 2013 study, it was estimated that 13% of patients with gastroesophageal reflux disease (GERD) reported experiencing regurgitation at least 4 days a week.
The other third common symptom for GERD condition is dysphagia which is common in older adults. This symptom is associated with difficulty in the swallowing process as food doesn’t go down the esophagus easily.
Most patients with the GERD condition usually report sticking of food in the chest. At times, it can be an abnormal awareness of food going down the esophagus. This is a result of the esophagus becoming increasingly sensitive.
Individuals who have GERD may experience a type of dysphagia known as esophageal dysphagia which is associated with blockage or irritation of the esophagus. Therefore, if you have difficulty swallowing food, it is advised to check with your doctor for the GERD condition.
Individuals who have GERD are at a higher risk of being diagnosed with dysphagia. However, this symptom should not be confused with odynophagia which is pain experienced when swallowing.
Dyspepsia or ingestion is a collection of symptoms that cause pain or discomfort in the upper abdomen. These symptoms include nausea, bloating, burping, or discomfort shortly after consuming food or drink. Although dyspepsia is sometimes caused by the type of food eaten, it can also be caused by digestive conditions like GERD where the stomach acid goes back to the esophagus and comes into contact with mucosa, a sensitive stomach lining.
The acid breaks down the mucosa, thereby causing damage to the esophagus in a way that it becomes narrow and constricted. Due to the strictures, the patient may now find it hard to swallow food as it can get stuck in the throat and cause chest pain. You should, therefore, not assume any pain or discomfort in the upper abdomen as this could be a symptom of acid reflux.
5. Bad Breath
As a result of regurgitation and heartburn which cause a bad taste in the mouth, recurrent reflux of stomach acids is likely to cause bad breath. Also known as halitosis, bad breath is a common issue that is believed to affect 1 out of every 4 people daily. Although there are other potential causes of bad breath, GERD is one of the causes of halitosis. Halitosis is considered an extra-esophageal symptom of gastroesophageal reflux disease.
6. Excessive Saliva
Someone with GERD may notice having excessive saliva as a result of esophagus acidification. Research shows that reflexive saliva stimulation occurs when stomach acid is infused in the upper esophagus as opposed to the lower esophagus.
It is believed that saliva is produced to dilute stomach acid in order to protect the esophageal lining. Water brash usually occurs when the excess saliva mixes with stomach acid during reflux. This can cause a sour taste or heartburn in some cases as the acid irritates the throat.
7. Breathing Problems
Acid reflux can sometimes result in breathing problems such as asthma and chronic cough. The Center for Disease Control and Prevention notes that 27 million Americans are estimated to have asthma. People with asthma are likely to report symptoms like coughing, shortness of breath, wheezing, and chest tightness.
According to a 2019 study, it was determined that there was a bidirectional association between GERD and asthma. Based on the study which involved the National Sample Cohort, it was established that people who had gastroesophageal reflux disease (GERD) were more likely to have symptoms like asthma. This comes about when the acid in the esophagus signals the brain, thereby causing the airways to contract. This then causes asthma symptoms.
Similarly, asthma patients have a higher risk of getting GERD than those who don’t have asthma. In fact, it is estimated that the occurrence of GERD was 34% to 80% in patients with asthma. Asthma triggers GERD in that it causes the airways to tighten, and this tends to increase the pressure in the esophagus. As a result, the acid creeps back into the esophagus.
In cases wherein a person experiences symptoms such as shortness of breath, it can be difficult to tell whether it is caused by GERD or asthma. A case study done in 2015 determined that some typical symptoms of GERD such as shortness of breath, belching, or burping could be linked to symptoms of asthma.
Also, a recent study showed that atypical symptoms like chest tightness, cardiac palpation, and chest pain have been reported as signs of asthma. There is, therefore, a need for proper diagnosis of GERD and asthma in patients. Chest pain may also be an indication of the GERD condition. However, it should be diagnosed early on as it could lead to other serious conditions.
8. Sore Throat or Hoarseness
Some people who have GERD may experience a sore throat. Acid reflux is caused by a weak lower esophageal sphincter since it allows stomach acids to flow back to the esophagus and throat. This condition is known as laryngopharyngeal reflux (LPR). Ultimately, this damages the throat (pharynx) and voice box (larynx).
When gastric acid reaches the voice box, it becomes irritated and can result in inflammation. This then results in sore throat, hoarseness, and coughing as well as frequent throat clearing. People who are suffering from acid reflux may also feel the sensation that something is stuck in their throat.
9. Dental Erosion
If you have damaged teeth, it may be an indication that you have gastroesophageal reflux disease. A 2012 study notes that 30% of GERD patients suffered from dental erosion. This symptom is described by dissolving and wearing away of the tooth enamel.
Normally, the lower esophageal sphincter keeps the stomach acids from the esophagus. However, if you have GERD or acid reflux, the muscle weakens, and this causes the stomach acids to enter the mouth from the stomach.
When the stomach acid comes to the surface of the teeth, it can cause substantial damage which leads to dental erosion. Dental erosion makes the teeth enamel vulnerable to damage, decay, and discoloration. Most GERD patients don’t notice the progressive loss of their tooth until it gets to the advanced stage.
Another common symptom of GERD is nausea. Nausea is caused by acid reflux or heartburn which is a common symptom of GERD. Nausea creates the sensation to vomit or feel sick. One study done on patients with gastroesophageal reflux disease found out that nausea is the common atypical symptom of GERD.
As explained above, a weak lower esophageal sphincter allows stomach acids to pass through the esophagus and into the mouth. This leaves a sour taste in the mouth which can contribute to nausea. Additionally, other symptoms associated with GERD such as coughing and burping can cause nausea or vomiting in extreme cases.
11. Persistent Hiccups
Persistent hiccups are associated with gastroesophageal reflux disease. Hiccup is basically the involuntary contraction of the inspiratory muscles that take part in breathing. Hiccupping causes closure of the glottis which is the space between the vocal folds, thereby producing a hiccup sound.
Though there are numerous causes of hiccups, it is reported to be an atypical symptom of GERD. Studies show that reflex excitation of the receptors in the esophagus can send impulses to the CNS through the vagus nerve. What follows is the excitation of the respiratory motor neurons which are responsible for hiccups. In most cases, babies who suffer from GERD condition are more susceptible to hiccups.
Hiccups can be annoying and distressing; nonetheless, most hiccups are harmless and are not a call for concern. Besides, a 2009 study showed that hiccup is prevalent in males with GERD than in women with GERD.
12. Inconsolable Crying
Just like adults, infants and children are also prone to GERD condition. The symptoms of GERD in children may vary, and they may have a single symptom or many symptoms. One of the common symptoms of GERD in children is inconsolable crying. When your child has GERD, you may find that they cry for food and then pull it away only to cry for it again.
Other symptoms of GERD in children include vomiting, coughing, burping, failure to gain weight, wheezing, and effortless spitting up. It is estimated that 35% of the children born in the US may experience spitting up which is associated with difficulties of reflux. Most of these symptoms may go unnoticed since it is difficult for children to express how they feel.
The symptoms for GERD can vary from one person to another, with some people experiencing mild symptoms. Non-erosive GERD is when the patient experiences the symptoms without any tissue damage.
If you experience any of the above symptoms, chances are you suffering from gastroesophageal reflux disease (GERD). These symptoms should not be ignored as the stomach acid can cause damage to your esophagus lining.
Make sure to consult your doctor and make the necessary lifestyle changes that will help you control these symptoms. For further diagnosis, your doctor can refer you to a gastroenterologist which is an expert in gut medicine.