Heartburn pain is sometimes mistaken for the pain associated withheart disease or a heart attack, but there are differences. Exercise may aggravate pain resulting from heart disease, and rest may relieve the pain. Heartburn pain is less likely to be associated with physical activity. But you can’t tell the difference, so seek immediate medical help if you have any chest pain.GERD redirects here. For the dam under construction in Ethiopia, see Grand Ethiopian Renaissance Dam.

Adults

The most-common symptoms of GERD in adults are heartburn^[6] and regurgitation. Less-common symptoms include pain with swallowing/sore throat, increased salivation (also known as water brash),nausea,^[7] chest pain, and coughing.

GERD sometimes causes injury of the esophagus. These injuries may include one or more of the following:

• Reflux esophagitis – necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus
• Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation
• Barrett's esophagus – intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus^[8]
• Esophageal adenocarcinoma – a form of cancer^[7]

Some people^[who?] have proposed that symptoms such as sinusitis, recurrent ear infections, and idiopathic pulmonary fibrosis are due to GERD; however, a causative role has not been established.^{[7][not in citation given]}

Children

GERD may be difficult to detect in infants and children, since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.

Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as 'spitting up'.^[9] One theory for this is the "fourth trimester theory" which notes most animals are born with significant mobility, but humans are relatively helpless at birth, and suggests there may have once been a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate the development of larger heads and brains and allow them to pass through the birth canal and this leaves them with partially undeveloped digestive systems.

Most children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true when a family history of GERD is present.

Barrett's esophagus

GERD may lead to Barrett's esophagus, a type of intestinal metaplasia,^[8] which is in turn a precursor condition for esophageal cancer. The risk of progression from Barrett's to dysplasia is uncertain, but is estimated at about 20% of cases.^[10] Due to the risk of chronic heartburn progressing to Barrett's, EGD every five years is recommended for people with chronic heartburn, or who take drugs for chronic GERD.^[11]

Causes

GERD

GERD is caused by a failure of the lower esophageal sphincter. In healthy patients, the "Angle of His"—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.

Factors that can contribute to GERD:

• Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.^[12][13]
• Obesity: increasing body mass index is associated with more severe GERD.^[14] In a large series of 2,000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index.^[15]
• Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production.
• A high blood calcium level, which can increase gastrin production, leading to increased acidity.
• Scleroderma and systemic sclerosis, which can feature esophageal dysmotility.
• The use of medicines such as prednisolone.
• Visceroptosis or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.

GERD has been linked to a variety of respiratory and laryngeal complaints such as laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not clinically apparent. These atypical manifestations of GERD are commonly referred to as laryngopharyngeal reflux (LPR) or as extraesophageal reflux disease (EERD).

Factors that have been linked with GERD, but not conclusively:

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, acid reflux disease, or reflux (in babies and young children) is a chronic condition of mucosal damage caused by stomach acid coming up from the stomach into the esophagus[4] (chronic reflux). Occasional reflux causes heartburn, but chronic reflux leads to reflux esophagitis, GERD, and sometimes Barrett esophagus. GERD is usually caused by changes in the junction between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top of the stomach closed, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary. Treatment is typically via lifestyle changes and medications such as proton pump inhibitors, H2 receptor blockers or antacids with or without alginic acid.[5]Surgery may be an option in those who do not improve. In the Western world between 10 and 20% of the population is affected.[5]