A 61-year-old man, named Shawn, comes to the emergency department because of substernal chest pain and heartburn.
He mentions that his symptoms worsen typically after coffee, heavy meals or during times of stress.
He also feels the pain at night when he is lying in bed and has previously been woken from sleep by discomfort.
He has not noticed any dyspnea, diaphoresis, or palpitations but is currently experiencing some nausea and a sour taste in his mouth. Shawn also denies a history of previous cardiovascular conditions. His ECG is normal.
Shawn has gastroesophageal reflux disease, or GERD. GERD is a condition caused by a transient lower esophageal sphincter relaxation, which enables stomach contents and acid to re-enter esophagus and damage esophageal mucosa.
As a result, people with GERD present with symptoms such as retrosternal chest pain, heartburn, regurgitation, and dysphagia.
It’s important to note that GERD symptoms tend to worsen after eating, when lying down, or bending over.
Now, if stomach acid gets to the throat, it can cause laryngopharyngeal reflux, which has a different set of symptoms such as acidic taste in the mouth, sore throat, chronic cough, and hoarseness.
In the mouth, gastric acid can even damage tooth enamel. Finally, if inhaled, stomach acid can cause pneumonia and asthma.
GERD is commonly associated with conditions such as decreased esophageal motility, gastric outlet obstruction, and hiatal hernia.
Risk factors for GERD include lifestyle habits such as caffeine, alcohol, and smoking; use of some medications, such as antihistamines and calcium channel blockers; but also, obesity; pregnancy; and Zollinger-Ellison syndrome.