The symptoms of gastroesophageal reflux disease arise mainly from the esophagus, and sometimes from structures above it.
Typical and less common symptoms
Heartburn and regurgitation are the main clinical manifestations of GERD, and chest pain and dysphagia are less common. The mechanism behind these symptoms is much more complicated than simple erosion of the mucosa: activation of afferent sensory nerves and visceral sensitivity also contribute, which is why symptom severity does not always match the visible injury.
Patients who have the less common symptoms, such as dysphagia and chest pain, undergo further evaluation, because these symptoms can indicate an alternative diagnosis, such as a cardiovascular disorder, or a more complicated case of GERD, such as a peptic stricture or esophageal adenocarcinoma.
Extra-esophageal symptoms and associated disorders
Some symptoms arise outside the esophagus. Laryngitis, chronic cough, asthma and dental erosion are recognised extra-esophageal symptoms of GERD.
A further group of disorders is associated with GERD: pharyngitis, chronic bronchitis, pulmonary fibrosis, chronic sinusitis, sleep apnea and cardiac arrhythmia. These are associations, not causal relationships.
Differential diagnosis
Because the clinical manifestations of GERD are not specific, the differential diagnosis is broad. It includes infectious and pill-induced esophagitis, eosinophilic esophagitis, peptic ulcer disease (PUD), dyspepsia, biliary colic, esophageal motility disorders, and coronary artery disease, which should be addressed first.