Case history

Case history

A 42-year-old woman has heartburn after meals and a sour taste in her mouth. For the past 4-6 months she has had symptoms several times per week. Symptoms are worse when she lies down or bends over. Antacids help somewhat. She has no dysphagia, vomiting, abdominal pain, exertional symptoms, melena, or weight loss. Past medical history and family history are noncontributory. The patient drinks alcohol occasionally and does not smoke. On physical exam, height is 5 feet 4 inches, weight 170 pounds, and blood pressure 140/88 mmHg. The remainder of the exam is unremarkable.

Other presentations

Patients may have only nocturnal symptoms. Traditional alarm symptoms are anemia, dysphagia, hematemesis, melena, persistent vomiting, and involuntary weight loss (>5% body weight), which raise the possibility of esophagitis, peptic stricture, or cancer.[9]

Extraesophageal symptoms are hoarseness (acid laryngitis), persistent nonproductive cough, pressure deep in the throat, and throat clearing. Extraesophageal manifestations include asthma, bronchitis, chest pain, oral disease, sinusitis, and recurrent pneumonia.[1]​​[4][5][6]​​​ In patients with GERD-associated asthma, there may be a negative family history; adult onset; wheezing exacerbated by exercise, meals, or supine position; nocturnal wheezing or cough; or reflux symptoms preceding asthma symptoms.[10]

Pregnancy and GERD

GERD symptoms (heartburn and regurgitation) are frequently observed during pregnancy. Prevalence of 30% to 80% has been reported.[11][12]​​​​ Symptoms are usually noted late in the first trimester or during the second trimester and tend to progress during the course of pregnancy.[11][12][13]​​​​ Symptoms typically resolve after delivery but may continue in some women after giving birth.[12]​ The other common gastrointestinal symptoms in pregnant women are nausea and vomiting, which can exacerbate esophageal injury and GERD symptoms. See Nausea and vomiting in pregnancy. Women with a history of GERD have higher chances of developing heartburn during pregnancy.[12]​ An early occurrence of GERD during pregnancy has been attributed to elevated levels of progesterone, which leads to the relaxation of smooth muscles, including the lower esophageal sphincter. Elevated progesterone decreases lower esophageal sphincter pressure, which results in gastroesophageal reflux. Elevated estrogen does not have a direct effect on lower esophageal sphincter pressure; however, an indirect contribution has been noted.​[12][14]​​ As serious complications are rarely encountered, upper endoscopy and other diagnostic tests are usually not required.[13]

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