Clinical features

These include (1,2):

• retrosternal or epigastric pain described by the patient as heartburn or a burning sensation:
  • aggravated by postural change such as bending, stooping, or lying down, and by tight clothing which forces acid up into the oesophagus.
  • may be referred to the neck, shoulder or arms, so mimicking angina.
• reflux is bitter or sour, reflecting its origin from the stomach. It is relieved by alkali.
• dysphagia - a late symptom. It may be caused by muscle spasm secondary to irritation, or be due to oedema, inflammation, spasm or rarely, stricture resulting from acid peptic regurgitation.
• "globus hystericus" - a chronic sensation of a foreign object lodged in the throat, tightness of the throat and a difficulty to initiate swallowing. Believed to be due to irritation and spasm in the cricopharyngeal sphincter region.
• respiratory symptoms - recurrent pneumonia, lung abscess and bronchiectasis - but a causal relationship is unproven. Coarse crepitations may be discernible at the lung bases.
• pallor due to occult bleeding and consequent anaemia and lethargy
• haematemesis - due to ulcerative bleeding.
• odynophagia

Reference:

1. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.
2. NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Clinical guideline CG184. Published: 03 September 2014 Last updated: 18 October 2019