Clues Pointing TO This Diagnosis

Classic GERD symptoms — heartburn — worse lying down — worse after meals — worse with triggers
Chronic dry cough — extraesophageal manifestation — acid reaching larynx
Risk factors — obesity — late night eating — alcohol — coffee — spicy food — tight clothing
Regurgitation — acid taste in mouth
Symptoms worse when recumbent — gravity no longer helping
Barrett's esophagus — metaplastic change — salmon colored on endoscopy
Confirmed on biopsy — intestinal metaplasia — goblet cells in esophageal lining
Requires surveillance endoscopy — increased risk of esophageal adenocarcinoma

Why It's NOT the Similar Diseases

NOT cardiac chest pain — cardiac pain is pressure or squeezing — radiates to arm or jaw — associated with exertion — not reliably related to meals or lying down. Steven's burning is postprandial — positional — food related — classic GERD. However cardiac causes must always be considered — ECG and troponin if uncertain.
NOT peptic ulcer disease — PUD causes gnawing epigastric pain — can cause bleeding — endoscopy shows ulceration not esophageal changes. Steven's symptoms are clearly esophageal.
NOT esophageal motility disorder — achalasia causes difficulty swallowing — regurgitation of undigested food — not acid burning — manometry shows aperistalsis.
NOT eosinophilic esophagitis — EoE causes dysphagia — food impaction — typically younger patients — biopsy shows eosinophilic infiltrate not intestinal metaplasia.
NOT gastric cancer — causes early satiety — weight loss — dysphagia — endoscopy shows mass not esophageal changes.

Differential Diagnosis List

Cardiac chest pain — ruled out by postprandial and positional character — ECG and troponin normal
Peptic ulcer disease — ruled out by esophageal burning — endoscopy showing esophageal changes not ulcer
Achalasia — ruled out by acid burning not dysphagia
Eosinophilic esophagitis — ruled out by age — acid symptoms predominating — biopsy showing intestinal metaplasia not eosinophils
Gastric cancer — ruled out by absence of alarm symptoms — endoscopy showing Barrett's not mass

Key Distinguishing Test

Upper endoscopy — gold standard — visualizes esophageal lining — identifies Barrett's — salmon colored mucosa — biopsies confirm intestinal metaplasia with goblet cells. pH monitoring — 24 hour ambulatory — confirms acid exposure if diagnosis uncertain. Empiric PPI trial — if symptoms resolve confirms GERD — but endoscopy needed if alarm symptoms or long-standing disease.

Board Note

📝 BARRETT'S AND CANCER RISK: Barrett's esophagus is the precursor to esophageal adenocarcinoma. Surveillance intervals — no dysplasia every 3 to 5 years — low grade dysplasia every 6 to 12 months with consideration of endoscopic eradication therapy — high grade dysplasia requires endoscopic intervention — RFA or EMR — not surveillance alone. HGD progression to adenocarcinoma is approximately 5 to 8% per year. ALARM SYMPTOMS requiring urgent endoscopy — dysphagia — odynophagia — weight loss — bleeding — anemia — vomiting — age above 60 with new onset symptoms.

“Steven’s Story”