Acid Reflux Symptoms & Diagnosis
ACID REFLUX SYMPTOMS
People who experience heartburn at least two to three times a week may have gastroesophageal reflux disease, or GERD. The most common symptom of GERD, heartburn, is estimated to affect 10 million adults in the United States on a daily basis. Heartburn is experienced as a burning sensation in the center of the chest, which sometimes spreads to the throat; there also may be an acid taste in the throat. Less common symptoms include:
Stomach pain (pain in the upper abdomen)
Non-burning chest pain
Difficulty swallowing (called dysphagia), or food getting stuck
Painful swallowing (called odynophagia)
Persistent laryngitis/hoarseness
Persistent sore throat
Chronic cough, new onset asthma, or asthma only at night
Regurgitation of foods/fluids; taste of acid in the throat
Sense of a lump in the throat
Worsening dental disease
Recurrent lung infections (called pneumonia)
Chronic sinusitis
Waking up with a choking sensation
When to seek help — The following signs and symptoms may indicate a more serious problem, and should be reported to a healthcare provider immediately:
Difficulty or pain with swallowing (feeling that food gets “stuck”)
Unexplained weight loss
Chest pain
Choking
Bleeding (vomiting blood or dark-colored stools)
ACID REFLUX DIAGNOSIS
Acid reflux is usually diagnosed based upon symptoms and the response to treatment. In people who have symptoms of acid reflux but no evidence of complications, a trial of treatment with lifestyle changes and in some cases, a medication, are often recommended, without testing. Specific testing is required when the diagnosis is unclear or if there are more serious signs or symptoms as described above.
It is important to rule out potentially life threatening problems that can cause symptoms similar to those of gastroesophageal reflux disease. This is particularly true with chest pain, since chest pain can also be a symptom of heart disease. When the symptoms are not life threatening and the diagnosis of gastroesophageal reflux disease is not clear, one or more of the following tests may be recommended.
Endoscopy — An upper endoscopy is commonly used to evaluate the esophagus. A small, flexible tube is passed into the esophagus, stomach, and small intestine. The tube has a light source and a camera that displays magnified images. Damage to the lining of these structures can be evaluated and a small sample of tissue (biopsy) can be taken to determine the extent of tissue damage.
24-hour esophageal pH study — A 24-hour esophageal pH study is the most direct way to measure the frequency of acid reflux, although the study is not always helpful in diagnosing gastroesophageal reflux disease or reflux-associated problems. It is usually reserved for people whose diagnosis is unclear after endoscopy or a trial of treatment. It is also useful for people who continue to have symptoms despite treatment.
The test involves inserting a thin tube through the nose and into the esophagus. The tube is left in the esophagus for 24 hours. During this time the patient keeps a diary of symptoms. The tube is attached to a small device that measures how often stomach acid is reaching the esophagus. The data are then analyzed to determine the frequency of reflux and the relationship of reflux to symptoms.
An alternate method for measuring pH uses a device that is attached to the esophagus and broadcasts pH information to a monitor worn outside of the body. This avoids the need for a tube in the esophagus and nose. The main disadvantage is that an endoscopy procedure is required to place the device (it does not require removal, but simply passes on its own in the stool).
Esophageal manometry — Esophageal manometry involves swallowing a tube that measures the muscle contractions of the esophagus. This can help to determine if the lower esophageal sphincter is functioning properly. This test is usually reserved for people in whom the diagnosis is unclear after other testing or in whom surgery for reflux disease is being considered.
ACID REFLUX COMPLICATIONS
The vast majority of patients with gastroesophageal reflux disease will not develop serious complications, particularly when reflux is adequately treated. However, a number of serious complications can arise in patients with severe gastroesophageal reflux disease.
Ulcers — Ulcers can form in the esophagus as a result of burning from stomach acid. In some cases, bleeding occurs. You may not be aware of bleeding, but it may be detected in a stool sample to test for traces of blood that may not be visible. This test is performed by putting a small amount of stool on a chemically coated card.
Stricture — Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus. The narrowing is caused by scar tissue that develops as a result of ulcers that repeatedly damage and then heal in the esophagus.
Lung and throat problems — Some people reflux acid into the throat, causing inflammation of the vocal cords, a sore throat, or a hoarse voice. The acid can be inhaled into the lungs and cause a type of pneumonia (aspiration pneumonia) or asthma symptoms. Chronic acid reflux into the lungs may eventually cause permanent lung damage, called pulmonary fibrosis or bronchiectasis.
Barrett’s esophagus — Barrett’s esophagus occurs when the normal cells that line the lower esophagus (squamous cells) are replaced by a different cell type (intestinal cells). This process usually results from repeated damage to the esophageal lining, and the most common cause is longstanding gastroesophageal reflux disease. The intestinal cells have a small risk of transforming into cancer cells.
As a result, people with Barrett’s esophagus are advised to have a periodic endoscopy to monitor for early warning signs of cancer.
Esophageal cancer — There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. A major risk factor for adenocarcinoma is Barrett’s esophagus, discussed above. Squamous cell carcinoma does not appear to be related to GERD. Unfortunately, adenocarcinoma of the esophagus is on the rise in the United States and in many other countries. However, only a small percentage of people with GERD will develop Barrett’s esophagus and an even smaller percentage will develop adenocarcinoma.
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