Clinical Features of Gastroesophageal Reflux Disease (GERD)

Typical Esophageal Symptoms

The American Thoracic Society notes that heartburn is a burning discomfort in the retrosternal area that moves upward toward the throat, occurring in approximately 89% of gastroenterology patients 1, 2
The American Gastroenterological Association states that acid regurgitation is the backflow of gastric contents into the esophagus or mouth, a common symptom of GERD 1, 2
Dysphagia, or difficulty swallowing, is reported in population-based studies, according to the American College of Gastroenterology 1
Typical symptoms, such as heartburn and regurgitation, are approximately 70% sensitive and specific for objective GERD, providing the rationale for empiric proton pump inhibitor trials without prior testing, as recommended by the American College of Gastroenterology 3, 4

The American Academy of Pediatrics notes that GERD can be completely silent from a gastrointestinal standpoint in up to 75% of patients when it causes chronic cough, making diagnosis challenging 1, 5, 6
Chronic cough is a common extraesophageal manifestation of GERD, accounting for 5-41% of chronic cough cases in adults, according to the American College of Chest Physicians 1, 5
Hoarseness is present in 100% of otolaryngology patients with laryngopharyngeal reflux disease, yet only 6% report heartburn, as reported by the American Academy of Otolaryngology 1, 2

The American Academy of Pediatrics states that regurgitation or "spitting up" is reported to occur daily in 50% of all infants as a normal physiologic process 7
Vomiting is a common symptom in infants, defined as the forceful expulsion of gastric contents via coordinated motor response, according to the American Academy of Pediatrics 7
Heartburn and regurgitation are similar to adult presentation in children and adolescents, as noted by the American Academy of Pediatrics 7

The American Academy of Pediatrics identifies neurologic impairment as the highest risk group for severe GERD 7
Obesity is both a risk factor and potential consequence of GERD, according to the American Heart Association 7
A history of repaired esophageal atresia is an anatomic predisposition to GERD, as noted by the American Academy of Pediatrics 7

Population studies show a 59% prevalence of occasional GER-related symptoms, according to the American College of Gastroenterology 1, 2
Weekly symptoms are reported by 20% of respondents in population-based studies, as noted by the American Gastroenterological Association 1, 2
Symptoms typically occur during meals and the postprandial state, according to the American College of Gastroenterology 8, 2

Gastroesophageal reflux is a normal physiologic process occurring up to 50 times daily in healthy individuals without producing symptoms, whereas GERD refers to disease manifested by troublesome symptoms and/or tissue damage, as defined by the American College of Gastroenterology 8, 2, 6

Barrett's esophagus is a premalignant condition, according to the American College of Gastroenterology 1
Esophageal adenocarcinoma is a long-term complication of GERD, as noted by the American Cancer Society 1
Pulmonary disease can occur from chronic aspiration, according to the American Thoracic Society 6

The American College of Chest Physicians recommends that when evaluating patients with chronic cough or atypical symptoms, the clinical profile should include absence of smoking history, normal chest radiograph, absence of upper respiratory symptoms, and failure to respond to bronchodilators 10