GERD Study Guide
GERD is a condition that develops when the reflux of the stomach contents causes troublesome
symptoms and/or complications
Erosive GERD: Endoscopic evidence of erosive findings
● Reflux esophagitis
● Reflux strictures
● Barrett esophagus
● Adenocarcinoma
Nonerosive Reflux Disease (NERD):
● Symptomatic syndrome
● No erosive findings
Heartburn: Substernal (lower chest) feeling of warmth or burning that may radiate to the neck
caused by acid reflux. It can be occasional or can be a symptom of GERD or PUD.
● Frequent Heartburn: Heartburn 2 or more times per week
Gastroesophageal (acid) reflux: Acid from the stomach moving backward into the esophagus
Gastroesophageal (acid) reflux disease (GERD): Common “medical condition” that refers to
troublesome typical symptoms >2 times per week OR damage to the esophageal mucosa caused
by retrograde movement of the gastric contents into the esophagus
● Symptomatic GERD (non-erosive reflux disease - NERD): Reflux symptoms in the
absence of endoscopic findings of mucosal damage in the esophagus
● Reflux esophagitis: Inflammation of the esophagus due to repeated or prolonged
exposure to gastric contents
● Erosive esophagitis: Erosion of the squamous epithelium of the esophagus
● Symptom severity is not equal to severity of mucosal damage
○ Just because there are severe symptoms does not mean there is severe damage
Complications of GERD (evaluate if diagnoses are present and if alarm symptoms are
present)
● Esophageal strictures
○ Narrowed esophagus due to scar tissue that forms secondary to recurrent
inflammation
● Barrett’s esophagus
○ Normal squamous epithelial lining replaced with columnar epithelium (precursor
lesion to esophageal adenocarcinoma)
, ● Esophageal adenocarcinoma
● Esophageal ulcers
● Perforation
The hallmark symptom of GERD is heartburn
● Typical GERD symptoms:
○ Heartburn
○ Regurgitation
○ Sour stomach
○ Water brash - excessive saliva that comes with a bitter taste
○ Belching
● Typical symptoms are usually exacerbated by:
○ Bending over
○ Recumbent position
○ High fat meals
Symptoms of GERD in infants:
● Refuse to eat
● Irritability
● Fussiness around mealtimes
● Frequent vomiting
● Hiccups
● Frequent cough
● Coughing fits at night
● Wheezing
Other GERD Symptoms
● Atypical symptoms (Extraesophageal)
○ Chronic cough
○ Laryngitis
○ Wheezing
○ Asthma
● Alarm symptoms (require evaluation):
○ Dysphagia (difficulty swallowing)
○ Odynophagia (painful swallowing)
○ Unexplained weight loss
○ Upper GI bleed
● Patients with GERD symptoms who also have alarm symptoms should have endoscopy
performed as soon as feasible. The endoscopic findings of erosive esophagitis and
Barrett’s esophagus are specific for diagnosis of GERD.
GERD is a condition that develops when the reflux of the stomach contents causes troublesome
symptoms and/or complications
Erosive GERD: Endoscopic evidence of erosive findings
● Reflux esophagitis
● Reflux strictures
● Barrett esophagus
● Adenocarcinoma
Nonerosive Reflux Disease (NERD):
● Symptomatic syndrome
● No erosive findings
Heartburn: Substernal (lower chest) feeling of warmth or burning that may radiate to the neck
caused by acid reflux. It can be occasional or can be a symptom of GERD or PUD.
● Frequent Heartburn: Heartburn 2 or more times per week
Gastroesophageal (acid) reflux: Acid from the stomach moving backward into the esophagus
Gastroesophageal (acid) reflux disease (GERD): Common “medical condition” that refers to
troublesome typical symptoms >2 times per week OR damage to the esophageal mucosa caused
by retrograde movement of the gastric contents into the esophagus
● Symptomatic GERD (non-erosive reflux disease - NERD): Reflux symptoms in the
absence of endoscopic findings of mucosal damage in the esophagus
● Reflux esophagitis: Inflammation of the esophagus due to repeated or prolonged
exposure to gastric contents
● Erosive esophagitis: Erosion of the squamous epithelium of the esophagus
● Symptom severity is not equal to severity of mucosal damage
○ Just because there are severe symptoms does not mean there is severe damage
Complications of GERD (evaluate if diagnoses are present and if alarm symptoms are
present)
● Esophageal strictures
○ Narrowed esophagus due to scar tissue that forms secondary to recurrent
inflammation
● Barrett’s esophagus
○ Normal squamous epithelial lining replaced with columnar epithelium (precursor
lesion to esophageal adenocarcinoma)
, ● Esophageal adenocarcinoma
● Esophageal ulcers
● Perforation
The hallmark symptom of GERD is heartburn
● Typical GERD symptoms:
○ Heartburn
○ Regurgitation
○ Sour stomach
○ Water brash - excessive saliva that comes with a bitter taste
○ Belching
● Typical symptoms are usually exacerbated by:
○ Bending over
○ Recumbent position
○ High fat meals
Symptoms of GERD in infants:
● Refuse to eat
● Irritability
● Fussiness around mealtimes
● Frequent vomiting
● Hiccups
● Frequent cough
● Coughing fits at night
● Wheezing
Other GERD Symptoms
● Atypical symptoms (Extraesophageal)
○ Chronic cough
○ Laryngitis
○ Wheezing
○ Asthma
● Alarm symptoms (require evaluation):
○ Dysphagia (difficulty swallowing)
○ Odynophagia (painful swallowing)
○ Unexplained weight loss
○ Upper GI bleed
● Patients with GERD symptoms who also have alarm symptoms should have endoscopy
performed as soon as feasible. The endoscopic findings of erosive esophagitis and
Barrett’s esophagus are specific for diagnosis of GERD.
