retrosternal or epigastric pain described by the patient as heartburn or a burning sensation:
aggravated by postural change such as bending, stooping, or lying down, and by tight clothing which forces acid up into the oesophagus.
may be referred to the neck, shoulder or arms, so mimicking angina.
reflux is bitter or sour, reflecting its origin from the stomach. It is relieved by alkali.
dysphagia - a late symptom. It may be caused by muscle spasm secondary to irritation, or be due to oedema, inflammation, spasm or rarely, stricture resulting from acid peptic regurgitation.
"globus hystericus" - a chronic sensation of a foreign object lodged in the throat, tightness of the throat and a difficulty to initiate swallowing. Believed to be due to irritation and spasm in the cricopharyngeal sphincter region.
respiratory symptoms - recurrent pneumonia, lung abscess and bronchiectasis - but a causal relationship is unproven. Coarse crepitations may be discernible at the lung bases.
pallor due to occult bleeding and consequent anaemia and lethargy
haematemesis - due to ulcerative bleeding.
odynophagia
Reference:
Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.
NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Clinical guideline CG184. Published: 03 September 2014 Last updated: 18 October 2019
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