Alarm Symptoms in Gastroesophageal Reflux Disease

Kenneth R. DeVault, MD, FACG

December 09, 2003

Question

What are the GERD alarm symptoms and what is their significance?

Response from Kenneth R. DeVault, MD, FACG

Many patients with gastroesophageal reflux disease (GERD) are appropriately treated with empiric therapy. Endoscopy is reserved for 2 groups of patients -- those with chronic symptoms who are at risk for Barrett's esophagus and those with alarm symptoms.[1] Commonly encountered alarm symptoms include: dysphagia (difficulty swallowing); odynophagia (painful swallowing); gastrointestinal bleeding or anemia; weight loss; and chest pain.

Dysphagia in combination with GERD usually signifies a peptic stricture, but can also be present in esophageal malignancies. Rarely, a patient with heartburn and dysphagia will turn out to not have GERD, but will have achalasia of the esophagus. Odynophagia is not a common GERD symptom and should alert the healthcare provider to consider other esophageal problems, such as pill-induced or fungal esophagitis. Overt gastrointestinal bleeding or anemia can occur in uncomplicated erosive esophagitis, especially in older patients,[2] but can also be a sign of gastrointestinal malignancy in any age group. Weight loss is not a common GERD symptom and should also be respected as a potential marker of an occult malignant process. Finally, GERD is one of the most common causes of noncardiac chest pain, but a potential cardiac etiology for chest pain must be respected even in patients with coexistent GERD.

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