As a consequence of the failure of the lower oesophageal sphincter (LES) reflux occurs.
Early stage of reflux (trumpet type B): Initially the failure of the LES only affects the lower end of the esophagus below the level of the diaphragm, i.e. the segment of the esophagus from the diaphragm to the stomach. This stages describes the early stage of the disease, this is trumpet type B.
In the presence of trumpet type B typical symptoms include gastric pain, burning sensation, fullness, gas bloat, wheezing, coughing, globus sensation („nodule“ in the throat), burning throat, tongue, mouth and gullet, chronic inflammation of the tonsils and sinusoids.
Advanced stage of reflux (trumpet type C): over time the failure of the LES also affects the segment of the esophagus above the level of the diaphragm, this stage describes the advanced stage of reflux, this is trumpet type C. During stage C the hole through which the esophagus passes the diaphragm enlarges < 3.0 cm (hiatal hernia).
Symptoms typical for trumpet type C include heartburn, acid regurgitation, chest pain, nausea, vomiting and asthma. Typically GERD symptoms (heartburn, coughing, globes sensation) disappear during eating and return 20 to 60 min after a meal.