Diagnostic Considerations

Gastroesophageal reflux may be classified into three categories, as follows:

Physiologic (or functional) gastroesophageal reflux: These patients have no underlying predisposing factors or conditions; growth and development are normal; and pharmacologic treatment is typically not necessary, though it may be needed to relieve symptoms if lifestyle changes are unsuccessful.^[7]
Pathologic gastroesophageal reflux or GERD: Patients frequently experience complications noted above, requiring careful evaluation and treatment^[26]
Secondary gastroesophageal reflux: This refers to a case in which an underlying condition may predispose to gastroesophageal reflux, with examples including asthma (a condition that may also be, in part, caused by or exacerbated by reflux) and gastric outlet obstruction

The diagnosis of GERD in patients with atypical symptoms can be difficult. When patients present with atypical complaints, the diagnosis of GERD must be kept in mind. Patients with recurrent aspiration can have asthma, history of pneumonias, and progressive pulmonary fibrosis. Additionally, hoarseness can be present due to chronic laryngeal irritation. Chest pain is another presenting symptom that can be difficult to evaluate. In these patients, excluding cardiac etiology is important prior to labeling the pain as noncardiac chest pain secondary to GERD.

The clinical presentation of GERD in pregnant women is similar to that for the general population. Heartburn and regurgitation are the cardinal symptoms. The diagnostic evaluation consists of a thorough history and physical examination.

Differential Diagnoses

Workup

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Media Gallery

Relationship of the phrenoesophageal ligament to the diaphragm and esophagus.
Arterial blood supply and lymphatic drainage of the esophagus.
Peptic esophagitis.
Reflux esophagitis is demonstrated on barium esophagram.
Gastroesophageal reflux disease (GERD)/Barrett esophagus/adenocarcinoma sequence.
Endoscopy demonstrating intraluminal esophageal cancer.
The image is a representation of concomitant intraesophageal pH and esophageal electrical impedance measurements. The vertical solid arrow indicates commencement of a nonacid gastroesophageal reflux (GER) episode (diagonal arrow). The vertical dashed arrow indicates the onset of a normal swallow.
Nissen fundoplication.
Laparoscopic Nissen fundoplication.
Hiatal hernia.

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Author

Marco G Patti, MD Surgeon, UNC Hospitals Multispecialty Surgery Clinic

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Piero Marco Fisichella, MD Assistant Professor of Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center.

Piero Marco Fisichella is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, and Society of American Gastrointestinal and Endoscopic Surgeons