Many people use the two terms interchangeably, but heartburn and acid reflux are not the same thing. Heartburn is a symptom of acid reflux, a condition in which stomach acid moves back up into the oesophagus. While heartburn is one of the most common signs of acid reflux, there are several other symptoms that can catch people off guard.
Acid reflux is common, but most people only experience it occasionally, usually after eating certain foods. Reflux can be triggered by fried or fatty foods, chocolate, tomato sauce, alcohol, coffee, carbonated drinks and vinegar. If you are dealing with acid reflux two or more days a week, it may be considered gastro-oesophageal reflux disease (GORD).
Some symptoms of acid reflux are easy to connect to the condition, while others are more surprising. “I also see reflux being blamed for symptoms that have nothing to do with it,” said gastroenterologist Dr Joseph Murray. That is why it helps to know both the common and less obvious symptoms of acid reflux, plus when it may be time to call your doctor.
Possible signs of acid reflux
Chest pain
It may sound cliché to confuse heartburn with a heart attack, but it does happen. “It’s not uncommon to see someone in the ER with terrible chest pain, thinking it’s a heart attack when it’s actually reflux,” Dr Murray said. Unfortunately, the opposite also happens, sometimes with tragic results. “Someone is having a heart attack, but they don’t go to the ER because they figure it’s indigestion,” he said.
One common heart attack symptom is tightness or pressure in the chest, arms or neck that comes with chest pain, which does not typically happen with reflux or GORD. When in doubt, go to the emergency department.
Excess saliva
If your mouth suddenly feels flooded with saliva after eating, that could be a sign of acid reflux, Dr Murray said. Much like how your mouth starts watering before you vomit, your salivary glands can go into high gear when they detect an irritant in your throat. They are preparing to wash away whatever is there, or what may be coming up.
Wheezing or trouble breathing
If you have trouble breathing, especially at night when you are lying down, reflux may be contributing. “When you lie down, acid washing up into the oesophagus can trigger a reflex that causes wheezing,” Dr Murray explained. “The acid can also go into airways and cause direct irritation, so you could be waking up choking and coughing.”
Trouble breathing may also happen after a large or fatty meal, after bending over, or after smoking or drinking alcohol. But if it comes on suddenly, there may be something else going on.
Regurgitation
Another sign of reflux is the sensation of food coming back up after you have eaten. It is not quite the same as vomiting. It can feel more like something is creeping up your throat into the back of your mouth without fully coming up and out.
Sour taste
Stomach juices that move up into your throat can also leave a sour or acidic taste in the back of your mouth. If eating seems to trigger a bitter taste in your mouth, acid reflux may be the cause.
Lump in your throat
Constantly feeling like there is a lump in your throat can be a sign of ongoing reflux, especially when it happens alongside other symptoms. But that is not always the case, Dr Murray said, as “dust or irritants” could also be behind frequent throat-clearing.
Burping
Frequent burping may be a sign that food is moving back up your oesophagus. Ongoing burping can also be linked to increased swallowing associated with GORD.
Difficulty swallowing
“Reflux can cause a narrowing of the throat due to damage and scarring, so food is actually being held up on its way down,” Dr Murray said. This can feel like food is scratching your throat as it moves towards your stomach, making swallowing feel more painful or difficult than it should.
Nausea
It makes sense that reflux may cause nausea, especially if you feel unwell after eating. The condition affects your digestive system, after all. While ongoing nausea is not always related to acid reflux, it can be one of the more common signs.
Coughing or sore throat
One type of acid reflux, laryngopharyngeal reflux, can cause less well-known symptoms such as coughing, hoarseness and a sore throat. If you have it, you may not experience more classic signs such as heartburn or indigestion.
But Dr Murray cautioned against jumping to conclusions. “Too often, a doctor sees a red throat and starts treating it with heavy-duty acid-blocking drugs,” he said. If you try those drugs for two weeks and do not notice an improvement, “something else may be going on,” like allergies or a sinus infection.
When to see a doctor about your acid reflux
Acid reflux is not usually life-threatening. But some symptoms can suggest the condition has become ongoing, which may increase your risk of complications.
When stomach acid escapes your stomach, it does not just irritate your throat. It can also make its way into your lungs. This can leave you with “a nasty case of pneumonia,” Dr Murray said. People with GORD also have a slightly higher risk of oesophageal cancer.
GORD can also lead to more serious complications beyond the symptoms above. Speak with your doctor if you experience loss of appetite, persistent vomiting, trouble swallowing, unexplained weight loss, vomit that looks like coffee grounds, or bloody or black stools. (The last two can be signs of bleeding in your digestive tract.
Chest pain can also signal a heart problem, which means you should seek immediate medical attention if you think you may be having a heart attack.
Acid reflux can also have a major effect on your quality of life, even without these more serious complications. Cutting out trigger foods and taking over-the-counter antacids may be enough to settle symptoms, but your doctor can also help you find the right treatment plan. Next steps may include prescription-strength options, such as proton pump inhibitors, if lifestyle changes and over-the-counter medicines do not ease your symptoms.
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