List typical symptoms.
Retrosternal burning pain (heartburn)
Regurgitation
Dysphagia, odynophagia
Water brash: a symptom of excessive salivation triggered by refluxing of stomach acid
List atypical symptoms.
Pressure sensation in the chest/noncardiac chest pain
Belching, bloating
Dyspepsia, epigastric pain
Nausea
Halitosis
Features of GERD complications, e.g., aspiration pneumonia or aspiration pneumonitis
List extraesophageal symptoms.
Chronic nonproductive cough and nighttime cough
Hoarseness
Bronchospasm
Dental erosion
List aggravating factors.
Lying down shortly after meals
Certain foods/beverages
What are red flags in GERD?
Anemia and/or evidence of GI bleeding (e.g., hematemesis, hematochezia)
Unintentional weight loss
Vomiting
Signs of GI bleeding
Presence of > 1 risk factor for Barrett esophagus
Describe the DD of esophagitis.
Esophagitis
Infectious esophagitis (typically seen in immunocompromised patients)
Esophageal candidiasis: Endoscopy shows white or yellow adherent plaques (pseudomembranes).
Herpes esophagitis (mainly HSV-1): Endoscopy shows superficial, punched-out ulcers in the distal esophagus in the absence of plaques.
CMV esophagitis: Endoscopy shows mucosal erosions and linear ulcers in the upper or middle esophagus, and viral inclusion bodies in cell nuclei on biopsy.
Drug-induced esophagitis: Some medications may cause esophageal mucosal irritation, leading to erosions and ulcers. [17]
Eosinophilic esophagitis
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