5 Acid Reflux Symptoms

–by Dr. Peng E. Wang

Introduction

What does acid reflux feel like? Symptoms such as heartburn, sore throat, cough, bad breath, and hoarseness are associated with acid reflux. Acid reflux is nearly synonymous with GERD (gastroesophageal reflux disease) nowadays, a phrase commonly used in Western culture, and up to 20% of adults have GERD symptoms weekly (ACG). What is acid reflux? What causes acid reflux? And most importantly, when is it time to get a professional evaluation for continued symptoms? In this article, let’s look at some symptoms of acid reflux, how it can occur, what factors play a role, what to ask, and when to seek professional care.

Acid Reflux

GERD is the prolonged reflux of stomach acid into the esophagus caused by various reasons. Although GERD is interchangeably used with acid reflux, both terms do not clarify the symptoms that can be associated with it.

1. “Heartburn”

By far, this is the most common word used to describe acid reflux symptoms, and rightly so, since it can mimic serious heart issues, thus the word “heart” is inclusive. When is it more than just acid reflux that you need to seek professional care? With the onset of heartburn, you should ask the following questions.

• A burning sensation radiating from the lower breast bone region into the upper chest?
• Sour acid taste with food upcoming sensation?
• Has it been an hour? One day? One week? More than three months?
• Is it improving, getting worse, on and off, or constant?
• Is it worse when lying down?
• Better with eating?
• Did you have something stimulating last night? Spices? Caffeine? Alcohol?
• Did you have a large meal last night?
• Do you have a fever? Yes? More likely a viral infection (stomach flu).
• Shortness of breath with unrelenting pressure, sweating, nausea? Please seek immediate medical care in person.
• Shooting pains down your arms, shoulder, and up to the neck? Please seek immediate medical care in person.

If you are having other symptoms associated with heartburn that may represent a heart attack, you need immediate attention. If you have heartburn that goes away when resting but worse when exercising, it’s more suggestive of a heart-related issue. Females are more likely to have standalone heartburn acting as a silent sign of a heart issue. While it’s not necessarily a heart attack, it may suggest blockages in the heart arteries causing insufficient blood flow (angina), which should not be ignored. Heartburn should be short-lived, but if it persists daily and it’s not relieved with antacids, you should seek medical attention.

2. Cough

Can acid reflux cause a cough? Absolutely. When you do not have heartburn but a persisting cough, it can be due to silent reflux. Stomach acid can reach your esophagus, and it can cause an ongoing cough due to esophagitis and laryngitis. While less likely to be an immediate concern than heartburn, you should ask the following questions regardless.

• Heartburn symptoms?
• Raspy, tickling, irritating cough?
• Cough not productive?
• Voice changes?
• Constantly clearing your throat?
• Feel like there is something in your throat?
• Eating late, within 2 hours of bedtime?
• Too much caffeine or alcohol?
• Had a stimulating meal (spicy, sour)?
• Weight loss? Please seek medical attention.
• Persistent more than 2 weeks? Consider antacids trial or medical attention.
• Fever? Likely a viral infection.

While a cough may be due to many other causes, a persistent cough without clear reasons could be due to silent reflux. If you do not have heartburn or the feeling of postnasal drainage, except a persistent cough, it’s fair to assume you may be getting silent reflux. A trial of over-the-counter antacids and lifestyle modification would be a good test.

Related article: 5 Common Causes of Cough

3. Sore throat

If you have a sore throat, you may think of an infection first, but not all sore throats are due to infections. Persistent sore throat without other associated symptoms is often related to drainage or acid reflux. Helpful questions to ask with the onset of a sore throat.

• Fever, body aches, fatigue? Viral upper respiratory infection likely
• Nausea, vomiting, diarrhea, fever? Stomach flu likely
• Nausea, vomiting, diarrhea, no fever? Food poisoning likely
• Sinus issues? Postnasal drainage likely
• Feeling drainage? No? Silent drainage occurs and can manifest as a sore throat
• Heartburn symptoms?
• A cough that’s not productive?
• Constantly clearing your throat?
• Trouble swallowing? Please seek urgent medical attention

Not all sore throats are created equal, and without a fever, it’s much less likely infectious, but rather, functional acid reflux or sinus drainage. Acid reflux can get bad enough to cause sinusitis, which then causes more drainage and sore throat. Your respiratory and gastrointestinal systems have a close interplay. When you have a persistent sore throat for weeks and weeks, try not to ignore it and consider an acid reflux management trial.

4. Bad breath

Halitosis is the technical word meaning unpleasant breath odor. While it’s less associated with acid reflux as a symptom, if you persistently have halitosis without obvious factors contributing, such as drainage, acid reflux should be on the list of possible causes. If this applies to you, you should ask these questions.

• Persistent bad breath despite brushing, flossing, mouthwashing?
• White spots on the tonsil that are removable?
• Eating too late? Within 2 hours of bedtime?
• Drank coffee within 4 hours of bedtime?
• Drank alcohol within 4 hours of bedtime?
• Waking up with a sore throat a lot?
• Waking up feeling there is something in the throat?
• Throat clearing all the time?
• Voice changes?

If you are getting tonsil stones causing bad breath, you are most likely getting acid reflux. When you eat late at night, the food is being digested while lying down, and the junction where your stomach and esophagus meet (LES) loosens, stomach acid can come up. Tonsil stones are the removable white bumps on your tonsils, typically in the pits of the tonsils, and they can be mistaken for ulcers and infections. In reality, they are regurgitated food materials that are stuck.

5. Hoarseness

Phonation is the process where your vocal cords vibrate and allow you to create sounds. This process can be affected by upcoming acid. The common symptoms are changes in your voice with a lower tone or loss of voice called hoarseness. Laryngitis means inflammation of your voice box (vocal cord); by itself, it does not mean changes to your voice, but a constant cough or throat clearing may mean acid reflux is causing laryngitis. Although less common than other symptoms of acid reflux, with the onset of sudden changes to your voice, there are a few questions to be asked.

• Constant throat clearing?
• Feel like there is always something in your throat. Globus sensation.
• Heartburn symptoms?
• Indigestion
• Coughing?
• Fever?
• Weight loss? Please seek medical attention.

Hoarseness of your voice in an illness, such as the common cold, you can assume it’s due to drainage and see if it improves after the cold resolves. However, if you have constant changes in your voice, and no other factors are likely contributing, you should consider a management trial for acid reflux. More importantly, if the voice change is associated with weight loss, fatigue, and prolonged feeling of unwell, you should seek urgent medical attention.

Potential causes of acid reflux

Acute (< 3 months)

Chronic (>3 months)

Indigestion -viral infection -food poisoning Changes in eating habits -FASTING >4 hours -Large meals before bed -Stimulating meals (spicy, sour) -Caffeine -Alcohol -Pregnancy Allergies and drainage

Gastroesophageal reflux (GERD) –Hiatal hernia (sliding of the stomach pass the diaphragm) –Barrett’s Esophagus (precancerous) –Sleep apnea (CPAP use ) –Radiation esophagitis -weak sphincter/muscle (LES) due to –>Smoking, alcohol, caffeine, obesity, medications Blockages, loosening of esophagus –Stricture (tightening) -esophageal mass (tumor) –Schatski’s Ring (horizontal web) –Zanker’s Diverticulum (outpouching of esophagus) Ulcerations (Peptic Ulcer Disease) -Infectious due to Helicobacter pylori -Medications such as NSAID (ibuprofen)

Conclusion

It is not impossible to cover all the causes of acid reflux in this article. The table above shows common causes of acid reflux but excludes the rare ones like neurological issues. The takeaway here is that if you have chronic symptoms consistent with GERD or acid reflux, despite medication trials, diet, and lifestyle modifications, you should seek medical attention. Suppose you had a complete evaluation with an EGD (esophagogastroduodenoscopy) that ruled out anatomical issues, and you had biopsies that ruled out precancerous changes (Barrett’s). In that case, you are dealing with functional reflux, which can be managed via lifestyle modifications and medications. Short-lived acid reflux symptoms are mostly not a concern. Nearly every person in their lifetime experiences different symptoms of acid reflux, many of them listed here.

Bonus: Decongestants, why you should avoid it

Can decongestants make you cough more due to reflux? Yes. The mechanism is more open airway by compressing the arteries lining the airway, thus allowing more space for drainage and more stomach upsets. Decongestants also cause rebound congestion, with elevated heart rate and blood pressure to a dangerous level. The difference between a vein and an artery is the amount of smooth muscle they are made of. Arteries have three layers of smooth muscle, and veins only have one. Veins are more elastic and compliant. Arteries are not very compressible. If you forcibly squeeze arteries by using decongestants, rebound congestion ensues. Bottles of nasal decongestants, such as Afrin (oxymetazoline), and others like phenylephrine in cold remedies, it’s best to avoid it.

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