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➤ Clinical Manifestations
• In individuals with obesity, clinical signs and symptoms resemble
those in the general population but are often more severe or
persistent, encompassing both esophageal and extraesophageal
symptoms.
▶ Esophageal symptoms include heartburn, typically retrosternal
and worse after meals or when recumbent, regurgitation,
dysphagia, odynophagia, and noncardiac chest pain.
▶ Extraesophageal manifestations, which may be the primary
presentation, include chronic cough, laryngitis or hoarseness,
asthma exacerbations, dental erosions, pharyngitis, and
globus sensation.
➤ Screening
• While universal screening for asymptomatic GERD is not
recommended, individuals with obesity warrant a lower threshold
for evaluation due to increased risks of Barrett esophagus and
esophageal adenocarcinoma. Alarm symptoms such as dysphagia,
odynophagia, weight loss, bleeding, or vomiting necessitate
prompt endoscopy. In the absence of these symptoms, endoscopic
screening may still be appropriate for those with additional risk
factors (e.g., age >50 years, male sex, White ethnicity, long-standing
GERD, central adiposity, smoking, or family history). The 2025
American Society for Gastrointestinal Endoscopy Guideline on the
Diagnosis and Management of GERD recommend endoscopy for
symptomatic individuals with obesity and prior bariatric surgery
(especially sleeve gastrectomy) and for asymptomatic postsleeve
patients. Surveillance is recommended at three years and every
f ive years thereafter.
➤ Diagnosis
• GERD is primarily a clinical diagnosis based on characteristic
symptoms.
