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Unrecognized Symptoms of GERD

Posted Feb 09 2012 9:47am
A man in his 60s came when his dentist discovered dental enamel was being eroded by acid. He neither tasted nor felt the acid. He denies ever having had heartburn or indigestion. Questioning revealed long-standing neck pain, belching, and discomfort in the sternum area of his chest. He also reported "irregular heart beat”. His primary care provider had recently performed 24-hour Holter monitor EKG to evaluate the cardiac palpitations. He reported being particularly annoyed by “runny nose” when he eats. I'm not sure which of these bothersome symptoms had been reported to his internist but I find each of them to be very significant.
(1)-GERD without heartburn is called atypical or silent GERD; when respiratory problems predominate the moniker is laryngopharyngeal reflux (LPR).
(2)-Erosion of dental enamel is clearly associated with gastroesophageal reflux disease (GERD).
(3)-Neck pain (pain in the cervical region, torticollis) is commonly encountered in GERD patients and in my experience nearly always resolves with successful treatment.
(4)-Irregular pulse beat or cardiac palpitation is commonly associated with GERD. A large study at the Veterans Administration Hospital found a very strong correlation between GERD and atrial fibrillation.... eight times more common than would've been expected by chance alone.
(5)-Runny nose at mealtime, in medical terminology gustatory rhinitis, is common in reflux patients and it can be very difficult to eradicate but often improves with successful treatment.
(6)-belching (eructation) is commonly associated with GERD; so are hiccups (singultus).
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