Could this be GERD

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Hello Doctor,

Thank you in advance for your time and advice.

About 4 weeks ago I started feeling like I had a lump in my throat, kind of like a pill got stuck.  No difficulty swallowing or breathing, really just a minor annoyance.  Then I started getting heartburn occasionally and seemed to be burping more frequently.  In the last week, the heartburn has progressed to nearly constant, I burp often, I seem to have excess salivia in my mouth (I noticed because spit seems to fly out of my mouth when speaking sometimes.) I also have the pressure/lump feeling in my throat along with pain in my upper back at the same level of my back as the chest pain.  I don't have discomfort at night.  I've tried tums and pepto, they only help for about 5 minutes.  I've never even had heartburn before, except in the last month of pregnancy.   My questions are:

Does this sound like GERD?

Can GERD cause one's upper back to hurt too?

The hearburn got much worse about the same time that I developed a really bad cold with lots of congestion, could this be related or just a coincidence?

I am going to see my PCP next week, any advice on questions that I should  ask?

Thanks for answering my many questions!

[Kevin Pho, MD]

Hello - thanks for asking your question.

GERD has many manifestations, which I will describe here.

The most common symptoms of GERD are heartburn (or pyrosis), regurgitation, and dysphagia. In addition, a variety of extraesophageal manifestations have been described including asthma, laryngitis, and chronic coughing. Heartburn is typically described as a retrosternal burning discomfort, radiating toward the neck. Regurgitation is the effortless return of gastric or esophageal contents into the pharynx without nausea, retching, or abdominal contractions. Patients typically regurgitate acidic material mixed with small amounts of undigested food.

GERD-related chest pain may mimic angina pectoris, and is typically described as squeezing or burning, located substernally and radiating to the back, neck, jaw or arms, lasting anywhere from minutes to hours, and resolving either spontaneously or with antacids. It usually occurs after meals, awakens patients from sleep, and may be exacerbated by emotional stress.

Globus sensation is the almost constant perception of a lump in the throat (irrespective of swallowing), which has been related to GERD in some studies. However, the role of esophageal reflux in this disorder is uncertain. One study suggested that globus was associated with a hypertensive upper esophageal sphincter rather than with reflux.

Water brash or hypersalivation is a relatively unusual symptom in which patients can foam at the mouth, secreting as much as 10 mL of saliva per minute in response to reflux, but can be seen in GERD.

GERD needs to be distinguished from gastritis, infectious esophagitis, pill esophagitis, peptic ulcer disease, non-ulcer dyspepsia, biliary tract disease, coronary artery disease, and esophageal motor disorders. Unexplained chest pain should be evaluated with an electrocardiogram and exercise stress test prior to a gastrointestinal evaluation. The remaining elements of the differential diagnosis can be evaluated by endoscopy or biliary tract ultrasonography.

The bottom line is that the symptoms that you have described can all be seen in GERD - however, you have to see your personal physician for a definitive diagnosis.  

Here are is a link that can help you:
Medline Plus - GERD
http://www.nlm.nih.gov/medlineplus/gastroesophagealrefluxhiatalhernia.html

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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One more question, if it is a reflux problem, can it heal and not return?  Or are the diet/lifestyle modifications I've been reading about permanent?

Thanks again.