Gastro Oesophageal Reflux Disease Differential Diagnosis Table

Gastro Oesophageal Reflux Disease
Differential Diagnosis Table:

Almost everyone has experienced heartburn and regurgitation once in their lifetime. These are very prominent symptoms of gastro-oesophageal reflux disease, one of the most common gastrointestinal disorders.
Gastro-oesophageal reflux is a regurgitation of stomach content back into the esophagus. When it occurs repeatedly, it causes injury and is then called Gastro-oesophageal reflux disease.
The most typical symptoms are heartburn and regurgitation. Others include difficult and painful swallowing, belching, abdominal pain, and nausea. Some symptoms can be unrelated to the gastrointestinal region like chest pain, globus sensation, erosion of dentition, hoarseness, sore throat, and coughing.

How To Distinguish Gastro-Oesophageal Reflux Disease from Other Diseases

Distinguish Gastritis from Gastro-Oesophageal Reflux Disease (GERD) – Diagnosis

Gastritis is defined as inflammation of the stomach mucosal lining. Evidence suggests that the majority of gastritis cases are asymptomatic; however, when they produce symptoms, they are very similar to gastroesophageal reflux disease (GERD).

• The typical symptoms of GERD are regurgitation and heartburn. Gastritis does not cause these symptoms.
• Moreover, acid reflux usually causes a sore throat, a bad taste in the mouth, and a sensation of a lump in the throat (globus sensation). Since gastritis has no acid reflux, none of these symptoms occur in gastritis.

Distinguish Peptic Ulcer from Gastro-Oesophageal Reflux Disease (GERD) – Diagnosis

Peptic ulcer is the discontinuation of the lining of the stomach, a portion of the upper intestine, and the lower esophagus due to gastric acids. As acid is the culprit of both these diseases, the treatment is somewhat similar, but the symptoms are not.

• The pain of the peptic ulcer is usually centered in the abdomen between the breastbone and the belly button. While GERD pain is associated with the esophagus, it can be in the chest and the throat.
• GERD can cause sore throat, hoarseness, and a bad taste in the mouth. Peptic ulcer, on the other hand, never causes these symptoms.
• Patients with peptic ulcer often see blood in their stool and vomit. It is a possibility that their stool appears completely black. This is uncommon among GERD patients.

“Both can be differentiated by the timings of their pain concerning food consumption. GERD pain usually starts immediately after ingestion. Peptic ulcers’ pain, typically duodenal ulcers, decreases after meal consumption, while gastric ulcer pain increases 2 to 3 hours after meal consumption.”

Distinguish Dyspepsia from Gastro-oesophageal Reflux Disease (GERD) – Diagnosis

Dyspepsia is a condition that causes recurrent pain and discomfort in the upper abdominal region. Both produce symptoms that overlap with each other, so differentiation is difficult.

• The major symptom that dyspepsia produces is a constant and recurring pain in the abdomen, while GERD pain is not constant; rather, it is triggered by factors. Usually, it starts after eating and lying down.
• GERD can produce changes in the throat and mouth. Typically, sore throat, feeling of a lump in the back of the throat, sensitivity in the teeth, etc. Dyspepsia is not associated with these.

Distinguish Angina from Gastro-Oesophageal Reflux Disease (GERD) – Diagnosis

Angina is a condition that arises due to reduced oxygen-rich blood flow to the heart. It produces chest pain, along with pain that radiates to the back, shoulder, and arm. As these symptoms resemble GERD, it is often confused with it.

• Angina chest pain increases on exertion and gets better on resting. However, GERD pain increases on resting, specifically lying down, as the acids get into the esophagus more easily when lying flat.
• Angina pain is often accompanied by breathlessness, while this is not present in GERD.
• Angina doesn’t cause belching and bloating, a very common manifestation of GERD.

Distinguish Gallbladder Disease from Gastro-Oesophageal Reflux Disease (GERD) – Diagnosis

Gallbladder disease refers to any condition that affects the gallbladder, producing infection, inflammation, gallstones, and tumors. Both of the conditions cause abdominal pain, therefore differentiation is crucial.

• GERD produces pain in the abdomen, which is accompanied by a burning sensation that starts from the stomach and goes up to the throat. Gallbladder diseases cause pain in the abdomen region, typically on the right side, that doesn’t move up to the throat.
• Acid reflux and regurgitation are the symptoms that define GERD; these are rare to be found in gallbladder conditions.
• In addition, GERD can make a person feel like having a lump in the throat while swallowing and an unpleasant taste in the mouth. Both are never observed among gallbladder diseases.

Distinguish Esophagitis from Gastro-Oesophageal Reflux Disease (GERD) – Diagnosis

Esophagitis is a disorder that arises due to inflammation of the esophageal mucosal membrane. Both of these conditions are often overlapping and are difficult to distinguish.

• It is very common for GERD patients to have difficulty in swallowing (dysphagia); however, esophagitis patients may also feel pain while swallowing (odynophagia) along with dysphagia.
• Food impaction is a common complication of esophagitis. This does not occur with GERD.

Distinguish Laryngopharyngeal Reflux (LPR) from Gastro-oesophageal Reflux Disease (GERD) – Diagnosis

Laryngopharyngeal reflux is a disorder caused by acid reflux back up to the throat, specifically the pharynx and larynx area.

• In GERD, the stomach acids travel up to the throat. Sometimes it changes its path and goes to the pharynx and larynx and produces LPR. Ultimately, the symptoms produced by GERD are commonly linked to the gastric tract and LPR to the respiratory.
• LPR causes excess mucus production, which can lead to post-nasal drip. This is not a common finding in GERD.
• Moreover, LPR commonly causes hoarseness, wheezing, and coughing, rare findings in GERD.

Distinguish Inflammatory Bowel Disease (IBD) from Gastro-Oesophageal Reflux Disease (GERD) – Diagnosis

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the tissues of the gastrointestinal tract, ultimately damaging it. It is comprised of two subtypes, Crohn’s disease and Ulcerative colitis.

• As discussed before, the typical symptoms of GERD are acid reflux and regurgitation. They never occur in any of the IBD subtypes.
• Due to inflammation of the intestinal lining, there is impaired water absorption, resulting in persistent diarrhea, and it is sometimes accompanied by blood. Since the etiology of GERD is completely different than IBD, these symptoms are not commonly associated with GERD.
• Moreover, excessive diarrhea leads to loss of nutrients, dehydration, and electrolyte imbalance. It results in weight loss, which is not seen in GERD patients.

Distinguish Achalasia from Gastro-oesophageal Reflux Disease (GERD) – Diagnosis

Achalasia is an esophageal smooth muscle motility disorder characterized by a lack of lower esophageal sphincter relaxation and peristalsis, resulting in functional obstruction near the inferior end of the esophagus. Both of these diseases might be difficult to differentiate; however, there are several differences among them.

• The ability of the lower esophageal sphincter to relax is the major distinction between the two conditions. In Achalasia, it doesn’t, so there is no connection between the esophagus and the stomach. In GERD, it is relaxed when it shouldn’t be, resulting in stomach contents, particularly acids, entering the esophagus. Ultimately, it causes burning pain in GERD, not present in Achalasia.
• As the food accumulates near the lower esophageal sphincter, regurgitation can occur, and the food doesn’t go into the stomach. This results in rapid weight loss due to a lack of nutrition. This is unusual in the case of GERD.

“During the investigation, Achalasia patients reveal a typical bullfrog neck or bird’s beak sign, not present in GERD.”

Important Red Flags With Gastro-Oesophageal Reflux Disease

Gastro-Oesophageal Reflux Disease is a common condition that is not life-threatening. People with GERD usually learn to live with it by avoiding the common triggers and undergoing therapy. GERD is diagnosed based on history and presenting symptoms, and no further investigations are done. There are, however, some red flags associated with it. These include,

• GERD symptoms reappearing twice or more weekly.
• Pain in the chest that is accompanied by a feeling of tightness, pressure, dizziness, and difficulty breathing.
• Blood in vomiting and stools
• Persistent diarrhea and vomiting
• Pain while swallowing (odynophagia)
• Unintentional weight loss
• Lymphadenopathy

It is important to further investigate if any of these are suspected, as they are the signs of some serious problem.