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10 Atypical GERD Symptoms You Should Know About
veryhealthy.life/10-atypical-gerd-symptoms-you-should-know-about/
The affliction known as acid reflux, most commonly referred to as heartburn, occurs when the acidic digestive juices in one’s stomach find its way into their esophagus. The popular presumption is that a diet rich in acidic content contributes greatly to the symptomatic display of acid reflux. After all, why would the stomach acid be overflowing unless there’s too much of it? Contrary to public assumption, it’s actually a low stomach acid and indigestion that are usually at fault.
And the esophagus, lacking the stomach’s protection of an appropriate lining, develops lesions and tissue scarring. If left untreated it may eventually result in the formation of esophageal cancer.
Despite being commonly mistaken for acid reflux, the symptoms of gastroesophageal reflux disease (or GERD) are generally more severe. But due to the low specificity of diagnostic testing currently rendered by physicians, it’s only in the presence of typical acid reflux symptoms like heartburn and regurgitation that GERD becomes easier to identify. But due to the difficulty in determining the cause-and-effect correlation between GERD and its atypical symptoms, many of them get brushed aside as merely indicative of common colds or flus.
Here are ten of the most overlooked atypical symptoms of GERD. Forewarned is forearmed!
1. Asthma
Of the estimated 15 million asthma sufferers in America, as many as 80% of their conditions can be linked to some form of GERD. While most asthma patients lament also having heartburn, pH monitoring has helped specialists deduce that up to 75% of them do also display an elevated esophageal acid exposure. A condition possibly induced by the asthma medications through eroding the esophagus natural protective membrane.
But an asthma patient need only concern themselves with the possibility of having GERD if their asthmatic symptoms become noticeably worse: after eating a big meal or drinking alcohol, when laying on their backs, or when their usual asthma medications seem to have little to no effect on improving their condition.
A big giveaway when differentiating GERD from asthma is acknowledging at which part of the breathing cycle one experiences the most difficulty or discomfort. While breathing in or out? People with acid reflux tend to have greater difficulty while breathing in, whereas asthma sufferers struggle more while breathing out.
2. Bronchitis
Usually caused by the same viruses responsible for colds and flu. While the immune system battles against these viruses, swelling occurs and the body produces excess mucus as a defense mechanism. This leads to swelling in the throat, increasing the likelihood of choking.
And if coughing cause reflux to be aspirated into the lungs, it might inflame they’re bronchial and eventually develop into bronchitis. Depending on the extent of the damage done to the bronchial tubes, exposure to common irritants like dust and smoke could be enough to further exacerbate the bronchial condition and GERD.
Should any stomach acid find its way into the bronchial tree, a case of acute bronchitis would be the most likely outcome. Acute bronchitis has a relatively short lifespan of only a few weeks. Whereas, chronic bronchitis can be long-lasting and prone to recurrence due to irritants like smoking. Your doctor would then prescribe having an X-ray done to rule out the possibility of you having contracted pneumonia.
3. Aspiration Pneumonia
Pulmonary aspiration is when a person manages to inhale foreign objects or substances into their lungs. This might include food, saliva, or stomach acid. It’s also possible for food to become inhaled after traveling back up the esophagus; on a return trip from the stomach. Anything aspirated, depending on its point of origin, could be infected with a variety of germs and bacteria that would affect the normal functioning of one’s pulmonary tree. If the lungs are unable to fend off the infection, pneumonia could develop as a consequence.
Typically, a person’s gag reflex functions as the primary agent in their defense against pulmonary aspiration; a cough, albeit violent, is usually enough to prevent a tragedy. But sometimes one’s gag reflex becomes impaired due to esophageal disorders, lung disease, and GERD, amongst several other possibilities. Depending on the cause of chronic aspiration, invasive surgery may be the only treatment to improve the condition.
4. Idiopathic Pulmonary Fibrosis (IPF)
IPF is a chronic lung disease that produces scarring in the lungs. Studies suggest that as many as 90% of all IPF sufferers also have gastroesophageal reflux disease, a link that was first reported in 1971. It’s believed that GERD exacerbates the situation over time by its aspiration of minute particles of stomach acid into the lungs. Certain studies have even indicated that an abnormal GERD is known to occur in those afflicted with IPF.
Proton pump inhibitors (PPIs, or acid regulating drugs) were studied to determine their effectiveness of affecting IPF progression. The initial trials, lasting several years, showed promise and acid regulating drugs were included in the treatment guidelines of IPF patients in 2015.
More recently, the findings of those initial trials have been brought into question, since the use of PPIs has been increasingly linked to the higher rates of lung infections in IPF patients. The conclusion being that anti-acid medications only change the acidic composition of the gastric juices aspirated—but does not actually prevent reflux itself.
5. Reflux Laryngitis
It is a voice disorder brought on by the swelling of the vocal folds due to reflux making its way up the esophagus. Stomach acid that reaches the throat is called laryngopharyngeal reflux. Although there are acidic and non-acidic variations of reflux disease, GERD, with its accompanying symptoms of heartburn, typically falls within the category.
But laryngopharyngeal reflux (LPR) patients don’t normally experience any heartburn, making it one of the more atypical examples of GERD. As such, LPR has come to be seen as a separate entity with a different host of requirements for its effective treatment, many of these treatments still being subject to much controversy.
Whether or not to even consider laryngopharyngeal reflux as a real disease is yet another hot topic of debate. But it’s feared this increased awareness of LPR may lead to overdiagnosis of the condition since LPR symptoms are nonspecific and have been known to occur even in cases of vocal abuse, smoking, alcohol abuse, the inhalation of irritants, allergies, and other common infections.
6. Chronic Cough
When a cough’s been endured for 3 weeks or more, the case is then classified as chronic. Which can become long-standing and typically non-productive in nature? And with chronic coughs accounting for nearly 40% of all referrals to pulmonary doctors, it’s the most common symptom of illness displayed in a primary care practice. Along with asthma and postnasal drip, and encompassing all age groups, GERD is 1 of the 3 most prevalent causes of chronic coughs diagnosed in primary care settings.
Oftentimes, a dry, hacking cough is the only manifestation of GERD in more than half of the cases treated, with many patients not even complaining of heartburn or regurgitation. And since several etiological factors might be at the root cause of a chronic cough, like asthma, it’s difficult establishing a cause-and-effect association between GERD and a chronic cough because either affliction might be the cause or effect of the other.
7. Hoarseness
This occurs when the GERD induced stomach acid in the esophagus irritates the vocal cords. Giving the impression of having a lump or mucus in their throats that they can’t seem to clear away. Typically, the voices of those inflicted sound more hoarse during the morning but will gradually improve throughout the day.
The structures of the throat (larynx, pharynx, and lungs) are quite sensitive to digestive enzymes (pepsin) and stomach acid, so even minute amounts of reflux in this region could result in some long-term, the extensive damage being done.
Most patients with hoarseness aren’t also afflicted with heartburn, making its connection to GERD much more difficult to establish. But once properly diagnosed as esophageal-laryngeal reflux (EPR), one of the most commonly seen ENT manifestations of GERD—which is associated with symptoms like hoarseness, frequent throat clearing, chronic cough, and voice fatigue—only then can effective prescriptions and treatments start being rendered.
8. Otitis Media (Ear Infection)
In a 2008 study of 893 ear samples (500 children), irrefutable evidence was discovered of a link between GERD and ear infections. This was established by monitoring for any signs of stomach acid has made its way to the middle ear, the only means of stomach acid or pepsin reaching the middle ear would be if it were refluxed.
They discovered that pepsin was present in the ears of at least 20% of the test subjects with chronic ear infections. Those with ear pepsin were more likely to also have a build-up of fluid in their ears. And children younger than a year old had a higher rate of ears infected with pus (purulent) as well as the presence of pepsinogen in the middle ear.
More recently, a Japanese study has indicated a link between otitis media with effusion (OME) and GERD in adults. Similar to the 2008 study of children, those displaying symptoms of GERD had higher middle ear pepsinogen levels. Proton pump inhibitor therapy was tested on four of the patients in the study. Which resulted in reductions in pepsinogen levels as well as reducing their overall GERD symptoms.
9. Non-Cardiac Chest Pains
While arguably belonging more to a category on cardiology, once it’s been established that one’s chest pains aren’t heart-related, GERD then becomes the most likely culprit. Acid reflux can cause sufficient pressure, or tightness, in the chest that the resultant pain becomes indistinguishable from those experienced during a cardiac arrest. In most cases, non-cardiac chest pains hinge on some affliction of the esophagus. But other causes include lung conditions, stomach problems, muscle and bone problems, anxiety, stress, and depression. www.cdc.gov/nchs/fastats/depression.htm
The discomfort felt during non-cardiac chest pains (NCCP) stem directly from the GERD’s effect on the esophagus, and indirectly from its effect on the windpipe and lungs. GERD-related chest pains are typically felt as a burning discomfort below the breastbone (or sternum), which may extend itself to the neck, jaws, back, and arms, in a similar fashion to actual cardiac chest pains (called angina). Acid reflux is said to account for anything from 22 to 66 percent of all reported cases of NCCP.
10. Sleep Apnea
Is a condition in which a person can be stirred from sleep due to their breathing patterns being interrupted; frequently stopping for brief periods at somewhat regular intervals. Even if the person doesn’t actually wake up, upon rising they tend to still feel fatigued as if they didn’t get a good night’s rest.
But, as with most of the atypical GERD symptoms covered so far, researchers are still working to discover the actual relationship between sleep apnea and GERD, but current indications do point to there being a definite connection. It’s been estimated that as many as 75% of people afflicted with sleep apnea also have GERD.
A study of 48 adults who displayed GERD symptoms at least thrice a week showed that those worst afflicted with GERD also had the worst quality of sleep. Doctors have also observed that the treatment of either disorder tends to improve the other condition as well.
Being diagnosed with both sleep apnea and GERD would require a person to be treated by at least two specialists: a pulmonologist for their sleep apnea; and a gastroenterologist for their gastroesophageal reflux disease.
10 Atypical GERD Symptoms You Should Know About
veryhealthy.life/10-atypical-gerd-symptoms-you-should-know-about/
The affliction known as acid reflux, most commonly referred to as heartburn, occurs when the acidic digestive juices in one’s stomach find its way into their esophagus. The popular presumption is that a diet rich in acidic content contributes greatly to the symptomatic display of acid reflux. After all, why would the stomach acid be overflowing unless there’s too much of it? Contrary to public assumption, it’s actually a low stomach acid and indigestion that are usually at fault.
And the esophagus, lacking the stomach’s protection of an appropriate lining, develops lesions and tissue scarring. If left untreated it may eventually result in the formation of esophageal cancer.
Despite being commonly mistaken for acid reflux, the symptoms of gastroesophageal reflux disease (or GERD) are generally more severe. But due to the low specificity of diagnostic testing currently rendered by physicians, it’s only in the presence of typical acid reflux symptoms like heartburn and regurgitation that GERD becomes easier to identify. But due to the difficulty in determining the cause-and-effect correlation between GERD and its atypical symptoms, many of them get brushed aside as merely indicative of common colds or flus.
Here are ten of the most overlooked atypical symptoms of GERD. Forewarned is forearmed!
1. Asthma
Of the estimated 15 million asthma sufferers in America, as many as 80% of their conditions can be linked to some form of GERD. While most asthma patients lament also having heartburn, pH monitoring has helped specialists deduce that up to 75% of them do also display an elevated esophageal acid exposure. A condition possibly induced by the asthma medications through eroding the esophagus natural protective membrane.
But an asthma patient need only concern themselves with the possibility of having GERD if their asthmatic symptoms become noticeably worse: after eating a big meal or drinking alcohol, when laying on their backs, or when their usual asthma medications seem to have little to no effect on improving their condition.
A big giveaway when differentiating GERD from asthma is acknowledging at which part of the breathing cycle one experiences the most difficulty or discomfort. While breathing in or out? People with acid reflux tend to have greater difficulty while breathing in, whereas asthma sufferers struggle more while breathing out.
2. Bronchitis
Usually caused by the same viruses responsible for colds and flu. While the immune system battles against these viruses, swelling occurs and the body produces excess mucus as a defense mechanism. This leads to swelling in the throat, increasing the likelihood of choking.
And if coughing cause reflux to be aspirated into the lungs, it might inflame they’re bronchial and eventually develop into bronchitis. Depending on the extent of the damage done to the bronchial tubes, exposure to common irritants like dust and smoke could be enough to further exacerbate the bronchial condition and GERD.
Should any stomach acid find its way into the bronchial tree, a case of acute bronchitis would be the most likely outcome. Acute bronchitis has a relatively short lifespan of only a few weeks. Whereas, chronic bronchitis can be long-lasting and prone to recurrence due to irritants like smoking. Your doctor would then prescribe having an X-ray done to rule out the possibility of you having contracted pneumonia.
3. Aspiration Pneumonia
Pulmonary aspiration is when a person manages to inhale foreign objects or substances into their lungs. This might include food, saliva, or stomach acid. It’s also possible for food to become inhaled after traveling back up the esophagus; on a return trip from the stomach. Anything aspirated, depending on its point of origin, could be infected with a variety of germs and bacteria that would affect the normal functioning of one’s pulmonary tree. If the lungs are unable to fend off the infection, pneumonia could develop as a consequence.
Typically, a person’s gag reflex functions as the primary agent in their defense against pulmonary aspiration; a cough, albeit violent, is usually enough to prevent a tragedy. But sometimes one’s gag reflex becomes impaired due to esophageal disorders, lung disease, and GERD, amongst several other possibilities. Depending on the cause of chronic aspiration, invasive surgery may be the only treatment to improve the condition.
4. Idiopathic Pulmonary Fibrosis (IPF)
IPF is a chronic lung disease that produces scarring in the lungs. Studies suggest that as many as 90% of all IPF sufferers also have gastroesophageal reflux disease, a link that was first reported in 1971. It’s believed that GERD exacerbates the situation over time by its aspiration of minute particles of stomach acid into the lungs. Certain studies have even indicated that an abnormal GERD is known to occur in those afflicted with IPF.
Proton pump inhibitors (PPIs, or acid regulating drugs) were studied to determine their effectiveness of affecting IPF progression. The initial trials, lasting several years, showed promise and acid regulating drugs were included in the treatment guidelines of IPF patients in 2015.
More recently, the findings of those initial trials have been brought into question, since the use of PPIs has been increasingly linked to the higher rates of lung infections in IPF patients. The conclusion being that anti-acid medications only change the acidic composition of the gastric juices aspirated—but does not actually prevent reflux itself.
5. Reflux Laryngitis
It is a voice disorder brought on by the swelling of the vocal folds due to reflux making its way up the esophagus. Stomach acid that reaches the throat is called laryngopharyngeal reflux. Although there are acidic and non-acidic variations of reflux disease, GERD, with its accompanying symptoms of heartburn, typically falls within the category.
But laryngopharyngeal reflux (LPR) patients don’t normally experience any heartburn, making it one of the more atypical examples of GERD. As such, LPR has come to be seen as a separate entity with a different host of requirements for its effective treatment, many of these treatments still being subject to much controversy.
Whether or not to even consider laryngopharyngeal reflux as a real disease is yet another hot topic of debate. But it’s feared this increased awareness of LPR may lead to overdiagnosis of the condition since LPR symptoms are nonspecific and have been known to occur even in cases of vocal abuse, smoking, alcohol abuse, the inhalation of irritants, allergies, and other common infections.
6. Chronic Cough
When a cough’s been endured for 3 weeks or more, the case is then classified as chronic. Which can become long-standing and typically non-productive in nature? And with chronic coughs accounting for nearly 40% of all referrals to pulmonary doctors, it’s the most common symptom of illness displayed in a primary care practice. Along with asthma and postnasal drip, and encompassing all age groups, GERD is 1 of the 3 most prevalent causes of chronic coughs diagnosed in primary care settings.
Oftentimes, a dry, hacking cough is the only manifestation of GERD in more than half of the cases treated, with many patients not even complaining of heartburn or regurgitation. And since several etiological factors might be at the root cause of a chronic cough, like asthma, it’s difficult establishing a cause-and-effect association between GERD and a chronic cough because either affliction might be the cause or effect of the other.
7. Hoarseness
This occurs when the GERD induced stomach acid in the esophagus irritates the vocal cords. Giving the impression of having a lump or mucus in their throats that they can’t seem to clear away. Typically, the voices of those inflicted sound more hoarse during the morning but will gradually improve throughout the day.
The structures of the throat (larynx, pharynx, and lungs) are quite sensitive to digestive enzymes (pepsin) and stomach acid, so even minute amounts of reflux in this region could result in some long-term, the extensive damage being done.
Most patients with hoarseness aren’t also afflicted with heartburn, making its connection to GERD much more difficult to establish. But once properly diagnosed as esophageal-laryngeal reflux (EPR), one of the most commonly seen ENT manifestations of GERD—which is associated with symptoms like hoarseness, frequent throat clearing, chronic cough, and voice fatigue—only then can effective prescriptions and treatments start being rendered.
8. Otitis Media (Ear Infection)
In a 2008 study of 893 ear samples (500 children), irrefutable evidence was discovered of a link between GERD and ear infections. This was established by monitoring for any signs of stomach acid has made its way to the middle ear, the only means of stomach acid or pepsin reaching the middle ear would be if it were refluxed.
They discovered that pepsin was present in the ears of at least 20% of the test subjects with chronic ear infections. Those with ear pepsin were more likely to also have a build-up of fluid in their ears. And children younger than a year old had a higher rate of ears infected with pus (purulent) as well as the presence of pepsinogen in the middle ear.
More recently, a Japanese study has indicated a link between otitis media with effusion (OME) and GERD in adults. Similar to the 2008 study of children, those displaying symptoms of GERD had higher middle ear pepsinogen levels. Proton pump inhibitor therapy was tested on four of the patients in the study. Which resulted in reductions in pepsinogen levels as well as reducing their overall GERD symptoms.
9. Non-Cardiac Chest Pains
While arguably belonging more to a category on cardiology, once it’s been established that one’s chest pains aren’t heart-related, GERD then becomes the most likely culprit. Acid reflux can cause sufficient pressure, or tightness, in the chest that the resultant pain becomes indistinguishable from those experienced during a cardiac arrest. In most cases, non-cardiac chest pains hinge on some affliction of the esophagus. But other causes include lung conditions, stomach problems, muscle and bone problems, anxiety, stress, and depression. www.cdc.gov/nchs/fastats/depression.htm
The discomfort felt during non-cardiac chest pains (NCCP) stem directly from the GERD’s effect on the esophagus, and indirectly from its effect on the windpipe and lungs. GERD-related chest pains are typically felt as a burning discomfort below the breastbone (or sternum), which may extend itself to the neck, jaws, back, and arms, in a similar fashion to actual cardiac chest pains (called angina). Acid reflux is said to account for anything from 22 to 66 percent of all reported cases of NCCP.
10. Sleep Apnea
Is a condition in which a person can be stirred from sleep due to their breathing patterns being interrupted; frequently stopping for brief periods at somewhat regular intervals. Even if the person doesn’t actually wake up, upon rising they tend to still feel fatigued as if they didn’t get a good night’s rest.
But, as with most of the atypical GERD symptoms covered so far, researchers are still working to discover the actual relationship between sleep apnea and GERD, but current indications do point to there being a definite connection. It’s been estimated that as many as 75% of people afflicted with sleep apnea also have GERD.
A study of 48 adults who displayed GERD symptoms at least thrice a week showed that those worst afflicted with GERD also had the worst quality of sleep. Doctors have also observed that the treatment of either disorder tends to improve the other condition as well.
Being diagnosed with both sleep apnea and GERD would require a person to be treated by at least two specialists: a pulmonologist for their sleep apnea; and a gastroenterologist for their gastroesophageal reflux disease.