Gastroesophageal Reflux Disease (GERD) (cont.)
What are the symptoms of uncomplicated GERD?
The symptoms of uncomplicated GERD are primarily heartburn, regurgitation,
and nausea. Other symptoms occur when there are complications of GERD and will
be discussed with the complications.
Heartburn
When acid refluxes back into the esophagus in patients with GERD, nerve
fibers in the esophagus are stimulated. This nerve stimulation results most
commonly in heartburn, the pain that is characteristic of GERD. Heartburn
usually is described as a burning pain in the middle of the chest. It may start
high in the abdomen or may extend up into the neck. In some patients, however,
the pain may be sharp or pressure-like, rather than burning. Such pain can mimic
heart pain (angina). In other patients, the pain may extend to the back.
Since
acid reflux is more common after meals, heartburn is more common after meals.
Heartburn is also more common when individuals lie down because without the
effects of gravity, reflux occurs more easily, and acid is returned to the stomach more slowly. Many patients with GERD are awakened from sleep by heartburn.
Episodes of heartburn may occur infrequently or frequently, but episodes tend
to happen periodically. This means that the episodes are more frequent or severe
for a period of several weeks or months, and then they become less frequent or
severe or even absent for several weeks or months. This periodicity of symptoms provides the rationale for intermittent treatment in patients with GERD who do not have esophagitis. Nevertheless, heartburn is a
life-long problem, and it almost always returns.
Regurgitation
Regurgitation is the appearance of refluxed liquid in the mouth. In most patients with GERD, usually only small quantities of liquid reach the esophagus, and the liquid remains in the lower esophagus. Occasionally in some patients with GERD, larger quantities of liquid, sometimes containing food, are refluxed and reach the upper esophagus.
At the upper end of the esophagus is the upper esophageal sphincter (UES).
The UES is a circular ring of muscle that is very similar in its actions to the
LES. That is, the UES prevents esophageal contents from backing up into the
throat. When small amounts of refluxed liquid and/or foods breach (get through)
the UES and enter the throat, there may be an acid taste in the mouth. If larger
quantities breach the UES, patients may suddenly find their mouths filled with
the liquid or food. What's more, frequent or prolonged regurgitation can lead
to acid-induced erosions of the teeth.
Nausea
Nausea is uncommon in GERD. In some patients, however, it may be frequent or
severe and may result in vomiting. In fact, in patients with unexplained nausea
and/or vomiting, GERD is one of the first conditions to be considered. It is not clear
why some patients with GERD develop mainly heartburn and others develop mainly
nausea.
Next: What are the complications of GERD? »
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