Is it just gas or GERD? How to tell the difference between digestive discomforts

Dyspepsia and Gastroesophageal reflux disease (GERD) both involve upper abdominal discomfort. However, their symptoms and underlying causes make them distinct from each other.

Signs and symptoms
Dyspepsia commonly referred to as gas represents a combination of symptoms which include upper abdominal pain, burning, early satiation and fullness involving the upper abdomen usually in close relation to food intake. It is broadly divided into functional and organic causes; wherein functional dyspepsia has no underlying cause after evaluation and organic dyspepsia is known to be due to a secondary cause like an infection or ulcer after evaluation.

GERD on the other hand, is due to the back flow of stomach contents into the lower esophagus (food pipe) which gives rise to classical symptoms of heartburn and regurgitation. It may also cause excessive salivation, lump in throat sensation, difficulty or pain in swallowing, chest pain, cough, hoarseness of voice and even nausea. It is primarily caused due to reduced functioning of the muscle at the bottom of the food pipe known as the lower esophageal sphincter. Conditions like obesity, pregnancy, advancing age, certain medications like estrogen supplements, nitrates, and dietary habits involving excess caffeine, chocolates, and peppermint may precipitate GERD. Smoking and alcohol are also major contributory factors.

Both conditions have alarming features which include:

• Weight loss
• Anaemia
• Presence of bleeding (vomiting blood, passage of black motion or stool tests being positive for blood)
• Difficulty in swallowing
• New onset symptoms in individuals above 60 years of age
• Presence of gastrointestinal cancer in relatives

These symptoms require urgent attention and some individuals may also experience them in combination. Both conditions are easy to treat if the symptoms are recognised and addressed in time. It is also important to find underlying causes, if any, and provide appropriate treatment.

Management and treatment
Individuals over 45-50 years of age and those with symptoms lasting 8 weeks and beyond must undergo evaluation. This includes history and examination, blood work in select individuals and upper GI endoscopy. Further evaluation may be done based on the results of the initial evaluation or in those with persistent symptoms. Management includes lifestyle modifications, dietary changes, anti-secretory therapy and treatment of underlying causes.

Dr. Raj Vigna Venugopal, HOD & Consultant – Medical Gastroenterology, Manipal Hospital Old Airport Road