Gastroesophageal reflux disease (GERD) is a common disease that refers to a syndrome in which stomach contents reflux into the esophagus, mouth, throat, airway and even into the lungs, resulting in a series of symptoms and complications. It is reported that about 20% to 40% of the western population has GERD symptoms. With the improvement of people’s living standard and the accelerated pace of life in China, the incidence of GERD is also on the rise year by year. The symptoms of GERD are diverse, and foreign studies have found up to more than 70 kinds, involving gastroenterology, respiratory medicine, ear, nose and throat and many other departments, so what symptoms can GERD have?
First, there are three typical symptoms, heartburn, acid reflux (regurgitation) and chest pain
1.Heartburn
Heartburn is the most common symptom of GERD, caused by the chemical irritation of acidic reflux on the nerve endings of the esophageal mucosa. It is manifested as a warm or burning sensation in the upper abdomen or behind the sternum, with typical symptoms appearing mostly 1 to 2 hours after a meal.
It can appear after overeating, drinking alcohol, coffee, or strong tea, and can also be triggered or aggravated by changes in posture such as bending, lying down, or lying on one’s back.
Patients with more reflux during sleep often wake up at night due to heartburn. Because the esophagus is inactive during deep sleep, the removal of reflux is slower and there is no gravitational effect to help eliminate it, and there is a lack of neutralizing effect of sleep fluid, so heartburn symptoms are more pronounced in patients with more frequent reflux at night.
2. Acid reflux (reflux food)
Acid reflux is the feeling of acid gushing upward from behind the sternum. The location of acid reflux gushing upward can reach behind the sternum, can reach the throat, and can also reach the mouth, and some people can even gush to the nasal cavity, and gushing to the throat can cause choking and coughing.
Reflux refers to the contents of the stomach gushing into the mouth without nausea and without exertion, coming back up as undigested food or mucus, and there can also be regurgitation of gas, that is, burping or belching.
3. Chest pain
Chest pain is mainly due to esophageal spasm caused by reflux stimulation. The pain is usually located in the posterior sternum, subxiphoid or upper abdomen, often radiating to the chest, abdomen, shoulders, neck and upper limbs, and is sometimes difficult to distinguish from angina pectoris.
Chest pain caused by GERD is often accompanied by acid reflux, heartburn, belching and other esophageal syndromes, and the nature of the pain is mostly burning pain, but it can also be needle-like pain or dull pain, and the pain attack is related to improper eating, position change, etc. Taking acid suppressants can gradually relieve the chest pain.
The site of angina is often located in the posterior sternum or left anterior chest, and can be radiated to the neck, back of the shoulder, left arm, left finger side, etc. The nature of the pain is pressure-like dull pain, colic, dull pain in the chest, often accompanied by chest suffocation, chest tightness or even a sense of suffocation, generally short duration, will gradually disappear within 3 to 5 minutes, often related to physical activity or emotional excitement and other factors, rest for a period of time or sublingual nitroglycerin can It can be relieved by rest or sublingual nitroglycerin.
Second, the symptoms involve multiple organs and are related to the arrival site of the reflux
1, reflux into the esophagus: In addition to the above typical symptoms, if there is severe reflux esophagitis or esophageal ulcer, there will be painful swallowing, and when there is esophageal spasm or dysfunction, some patients will have difficulty swallowing, and when esophageal stricture occurs, the difficulty in swallowing continues to worsen.
2, the reflux reaches the pharynx: when the reflux reaches the pharynx, the reflux stimulates the pharynx can cause chronic laryngitis or laryngopharyngitis, and like other causes of chronic pharyngitis, patients often show sore throat itching and hoarseness, pharyngeal discomfort, foreign body sensation, cotton ball sensation or blockage, but no swallowing difficulties, this symptom is called hysterical ball syndrome in Chinese medicine.
3.Reflux reaches the oral cavity, nasal cavity and middle ear: it can cause symptoms such as oral ulcers, runny nose, post-nasal drip, sneezing, nasal congestion, tinnitus and hearing loss.
4.Reflux reaches the trachea: it can cause cough, asthma,, breath-holding, aspiration pneumonia, etc. The common symptoms are chronic cough and asthma-like attacks.
Chronic cough is mainly caused by reflux stimulating the throat and activating the afferent nerves of the cough reflex, or it can be caused by direct stimulation of the tracheobronchial tree by the reflux.
Asthma-like attacks are caused by activation of the vagal arc from the esophagus to the lungs by reflux, resulting in tracheal spasm and an asthma attack. As with other causes of asthma, the patient usually presents with wheezing and/or shortness of breath.
Therefore, the possibility of gastroesophageal reflux should be considered for unexplained long-term chronic cough, choking, recurrent laryngospasm attacks, unexplained asthma, and recurrent aspiration pneumonia, which are closely related to diet, especially in elderly patients who are bedridden for a long time.
Third, why does GERD cause so many symptoms?
This is because GERD is characterized by reflux of gastric contents. In normal people, there is a large amount of gastric acid in the stomach. The main component of gastric acid is hydrochloric acid, which is very corrosive, and since the mucus cells of the stomach can secrete a mucus that forms a mucosal barrier on the surface of the stomach, it makes the gastric mucosa safe from the gastric acid. However, our esophagus, throat, mouth and trachea cannot tolerate a little stomach acid, so once gastroesophageal reflux occurs, the reflux of stomach contents containing stomach acid will cause symptoms in whichever organ it runs.
Moreover, the onset of GERD is related to gastrointestinal motility disorders, visceral sensory sensitivity, and psychosomatic factors, and often overlaps with other functional gastrointestinal disease symptoms, so the symptoms can be diverse.
IV. Do you have GERD?
Answer the following questions to test whether you are suffering from GERD.
1.Do you often have heartburn and often have trouble sleeping because of heartburn?
2. Do you have trouble swallowing food?
3.Does the food you eat sometimes reflux into your mouth?
4.Is there often acidic liquid reflux into the mouth?
5.Do you often have hiccups?
6.Do you often feel breathless when lying down in the middle of the night? Are the symptoms relieved when sitting up or raising the head of the bed?
7.Do you often feel chest pain but the results of heart tests are basically normal?
8. Do symptoms such as heartburn, dyspnea and acidity worsen after meals, when bending over or when sleeping?
If one of the above questions is answered “yes”, we should consider the possibility of GERD, and can clarify the diagnosis through gastroscopy, esophageal manometry and 24-hour pH monitoring.