GORD symptoms

Can you spot the typical and atypical symptoms of gastro-oesophageal reflux disease (GORD) in patients? Find out with this short review of GORD symptoms which also outlines signs of complications. This article forms part of our short course on GORD symptoms, red flags and management.

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Gastro-oesophageal reflux disease (GORD) is usually a chronic condition where there is reflux of gastric contents (particularly acid, bile, and pepsin) back into the oesophagus. GORD can be classified as non-erosive when symptoms of GORD are present but the endoscopy is normal, or erosive oesophagitis when oesophageal inflammation and mucosal erosions are seen at endoscopy.1

It is not unusual for a patient to experience the symptoms of GORD for many years before seeking medical help. GORD symptoms can be divided into those directly related to reflux and those caused by complications of the disease.

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GORD symptoms directly related to reflux

Typical GORD symptoms

Heartburn1

Acid regurgitation1

This classical symptom, reported in nearly all patients with GORD,2 is described as a burning sensation that arises from behind the sternum and extends upwards towards the throat.3 It may be accompanied by regurgitation and is most likely to occur after eating a large, spicy or fatty meal, or on bending or lying down.4 Regurgitation occurs with varying degrees of severity in approximately 80% of people with GORD.2 It is the reflux of the acidic gastric contents into the mouth causing a bitter or acid taste,3 but, unlike vomiting, it is not accompanied by contractions of the gastrointestinal tract or abdominal wall.

Other GORD symptoms include:

  • Earache5 – caused by acid damage to the oropharynx
  • Oral symptoms6 – tooth decay, halitosis or gingivitis, caused by the presence of acidic reflux in the mouth
  • Water brash,7 i.e. the sudden filling of the mouth with saliva in response to the presence of acid in the oesophagus
  • Throat symptoms 5– tight or sore throat, laryngitis or hoarseness, caused by acid damage to the larynx
  • Chest pain1,3
  • Pulmonary symptoms8 – asthma, chronic coughing, wheezing or pneumonia, caused by the aspiration of acidic reflux into the respiratory tract or by vagally induced bronchoconstriction in response to acidification of the oesophagus
  • Gastrointestinal symptoms3,4 – nausea, bloating


GORD symptoms caused by complications

Symptoms indicative of severe GORD or the presence of complications include:

  • Odynophagia9 – painful swallowing, usually associated with severe damage to the oesophageal mucosa
  • Dysphagia10 – long standing reflux may result in a peptic stricture.9 However, another common cause is a Schatzki ring11 (see figure below) at the lower end of the oesophagus. This is a fibrous ring often associated with a hiatus hernia10
  • Haematemesis12
  • Nocturnal choking attacks13
  • Unexplained weight loss.4

 
Hiatal hernia and Schatzki ring visible on a double contrast oesophagramFigure: Double contrast oesophagram showing hiatal hernia and Schatzki ring. Right arrow indicates the circumferential constriction at the distal oesophagus.
(Courtesy of Dr Carlos Andres Perez, Radiopaedia.org, rID: 38048)

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GORD symptoms - references

  1. Gastro-oesophageal reflux disease. BNF, [accessed June 2021]
  2. Kahrilas PJ, et al. Regurgitation in Patients with Gastroesophageal Reflux Disease. Gastroenterol Hepatol (N Y). 2013 Jan; 9(1): 37–39
  3. Symptoms & causes of GER & GERD. NIH, 2020
  4. Heartburn and acid reflux. NHS website, 2020
  5. Ahuja V, et al. Head and Neck Manifestations of Gastroesophageal Reflux Disease. Am Fam Physician. 1999 Sep 1;60(3):873-880.
  6. Gastro-oesophageal reflux disease (GORD). NHS Inform, Scotland, 2021
  7. Knott, L. Gastro-oesophageal Reflux Disease. info, 2020
  8. Gaude GS, et al. Pulmonary manifestations of gastroesophageal reflux disease. Ann Thorac Med. 2009 Jul-Sep; 4(3): 115–123.
  9. DeVault KR, et al. Alarm Symptoms in Gastroesophageal Reflux Disease. Medscape, 2003
  10. Dysphagia. Mayo Clinic, 2019
  11. Watts LD, et al. Schatzki Ring. StatPearls, 2020
  12. Vomiting blood. NHS website, 2019
  13. Orr WC. Management of Nighttime Gastroesophageal Reflux Disease. Gastroenterol Hepatol (N Y). 2007 Aug; 3(8): 605–606

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