The most common complaint in patients with GERD are heartburn, regurgitation, swallowing problems or more precisely the sensation of hang-up food in the lower sternal area. These represent the so-called "typical" symptoms of GERD. While none of these are specific to GERD, the latter is more commonly a sign of serious underlying pathology, including esophageal cancer. Problems swallowing should always be investigated promptly and thoroughly.
Many patients with GERD have "atypical" symptoms such as cough, asthma, hoarseness, sinusitis and noncardiac chest pain with or without associated heartburn and regurgitation. Atypical symptoms are the primary complaint in 25% of patients with GERD and are secondarily present in association with heartburn and regurgitation in many more.
It is more difficult to prove a cause and effect relationship between atypical symptoms and gastroesophageal reflux than it is for the typical symptoms. Often a trial of high dose proton pump inhibitor antacid medication is helpful. A 24-hour pH monitor is often necessary to make the diagnosis.
A review of the literature will show that 50% of patients with chest pain and negative coronary angiograms, 75% of patients with chronic hoarseness, and up to 80% of patients with asthma will have a positive 24-hour pH testing indicating abnormal acid reflux into the esophagus.