Symptoms of Gastroesophageal Reflux Disease (GERD)

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GERD symptoms
© Verywell, 2018 

Heartburn and acid regurgitation are the main symptoms of gastroesophageal reflux disease (GERD), though some people have GERD without heartburn. Other symptoms include pain in your chest and/or abdomen, difficulty swallowing, dry cough, hoarseness, nausea, vomiting, bad breath, wheezing, and interrupted sleep.

Frequent Symptoms

While GERD has some signature symptoms, it's worth looking more closely at exactly what it can cause for adults and children of various ages.

Adults and Teens

Chronic heartburn and gastroesophageal reflux disease (GERD) are often considered to be adult disorders, but they are becoming more common among teens. That's in part because of the popularity of fast food among people this age and their increasing weight. The symptoms tend to be the same for both teens and adults.

Whether or not you have heartburn, if you have GERD, you will likely experience some or all of these frequent symptoms, including:

  • Acid reflux: You might feel a burning sensation in your chest and/or abdomen, and you might taste stomach acid combined with whatever food you just ate, especially in the back of your throat. That's because the valve between your stomach and your esophagus—which carries your food from your mouth to your stomach—isn't closing properly, and it's allowing the contents of your stomach to move in the wrong direction, back up toward your mouth.
  • Chest or abdominal pain: This usually starts behind your breastbone, or sternum, and may travel up to your throat and radiate to your back. You may also feel pain in the upper or middle part of your abdomen. The pain usually occurs shortly after eating and can last from a few minutes to several hours. It's important to remember that sometimes the pain of a heart attack can be confused with the burning pain of GERD, and it's always important to seek medical attention if there is any doubt as to the origin of your chest pain.
  • Hoarseness: Irritation caused by refluxed stomach acid into your throat can lead to hoarseness or laryngitis, particularly in the morning.
  • Difficulty swallowing: Issues with swallowing, known as dysphagia, occur when food doesn't pass normally from your mouth through the esophagus to the stomach. There may be a sensation of food sticking in your throat, chest pressure or burning after eating, or a feeling of choking. Difficulty swallowing could be a sign of various conditions, including erosive esophagitis and esophageal cancer, and should always be evaluated by a physician.
  • Persistent dry cough: If refluxed stomach acid is aspirated, it can cause coughing. This cough can also cause a sore throat.
  • Bad breath: This can occur when acid from your stomach comes up into your throat and mouth.
  • Wheezing: You might feel like you're having difficulty breathing, and you may hear a whistling sound when you breathe.
  • Nausea or vomiting: GERD can cause nausea and/or regurgitation as well, which can lead to your teeth wearing away from the stomach acid.
  • Difficulty sleeping: GERD can interrupt your sleep if the symptoms are bothersome.

Younger children and older adults can experience GERD differently.

Infants

Gastroesophageal reflux is common in infants and is more often referred to by a more simple name: spitting up.

Reflux occurs during the first three months of age in more than half of all infants, and many babies outgrow the condition and don't require treatment. Referred to as "happy spitters," their symptoms usually disappear around 6 months of age and rarely occur past 18 months. However, for a small number of babies, symptoms of reflux are severe and medical evaluation and treatment is needed.

Because your baby can't tell you what's wrong, it's important to keep an eye out for symptoms. Common infant GERD symptoms include:

  • Frequent spitting up or vomiting: This can occur during or immediately after feeding, or at other times.
  • Irritability when feeding: This irritability includes whining, crying, screaming, and fussiness, which can last for varying amounts of time. It can stem from the burning sensation and pain in the esophagus when milk or formula and stomach acid is refluxed into the esophagus.
  • Refusing food or eating only small amounts: Related irritation of the esophagus can cause infants to refuse to eat, as pain may occur when they swallow.
  • Arching the back while feeding: When babies are experiencing abdominal pain or discomfort, they will often arch their backs or draw up their legs.
  • "Wet" burps: With this, a small amount of liquid is regurgitated as he or she burps.
  • Frequent hiccups: Hiccups can be triggered by the stimulation of nerves found in the upper part of the stomach or lower part of the esophagus. The vagus nerve, which runs from the brain to the abdomen, can become irritated. This irritation can come from stomach contents entering the esophagus.
  • Frequent coughing: A frequent cough may occur if refluxed stomach acid is aspirated, irritating the airways, or when the stomach acid irritates the throat.
  • Poor sleep habits with frequent waking: When an infant is sleeping and his or her head isn't elevated, this allows stomach contents to press against the lower esophageal sphincter (LES), and can cause it to open inappropriately. When stomach contents are refluxed into the esophagus, it can cause coughing and a choking sensation, which in turn can make sleeping more difficult.

Children

Gastroesophageal reflux (GER) often begins in infancy, but only a small number of infants continue to have reflux as older children. 

The following symptoms may occur if your child is experiencing acid reflux, and evaluation by a physician is advised if any persist:

  • Abdominal pain above the belly button
  • Chest pain
  • Burning sensation in the esophagus
  • Extreme pickiness about foods or refusing food
  • Eating only a few bites despite hunger
  • Gagging or choking
  • Poor weight gain or weight loss
  • Bad breath
  • Constantly runny nose
  • Frequent sore throat
  • Sinus infections
  • Respiratory problems such as bronchitis, wheezing, or asthma
  • Nighttime cough
  • Nagging dry cough
  • Hoarseness
  • Poor sleep, frequent waking
  • Frequent ear infections and/or ear congestion
  • Excessive salivation or drooling
  • Intolerant of pressure on the stomach

Elderly

Elderly patients may not connect their symptoms with heartburn or GERD because their symptoms may be different from what is considered the normal symptoms of the disease. Usually, when we think of the symptoms of GERD we think of heartburn. In the elderly, symptoms often show up in the mouth, throat, or lungs.

Symptoms that can occur in the throat include:

  • Hoarseness
  • Dry cough
  • Feeling like there is a lump in your throat or food stuck in your throat
  • Trouble swallowing (dysphagia)
  • Chronic sore throat
  • Respiratory symptoms, such as coughing and wheezing

Elderly patients with some chronic conditions are at a higher risk of developing GERD. They may take medications that cause the LES to relax, which can lead to acid reflux. The elderly patient also tends to have decreased saliva production. Saliva can help with acid reflux because saliva is alkaline, so it can help neutralize the acid. Saliva can also relieve heartburn by bathing the esophagus and lessening the effects of acid refluxed into the esophagus by washing it back down to the stomach.

Rare Symptoms

A very small number of infants will experience the following less common symptoms, including:

  • Difficulty swallowing: Pain caused by refluxed stomach acid into the esophagus can make it difficult for infants to swallow. An obstruction in the esophagus can also cause this, so any signs of swallowing difficulty need to be evaluated by a physician.
  • A frequent sore throat: When stomach contents back up into the throat, it can cause irritation and a sore throat.
  • Respiratory problems such as asthma, pneumonia, bronchitis, or wheezing: Several studies suggest a significant link between GERD and asthma. GERD can affect asthma when refluxed acid from the stomach is aspirated into the lungs and can make breathing difficult and cause your baby to wheeze and cough. This refluxed acid can cause other types of irritation in the lungs, leading to increased odds of pneumonia and bronchitis.
  • Excessive drooling: This usually occurs from improper, inefficient, or infrequent swallowing. If irritation is present in your baby's throat because of refluxed stomach acid, he or she may find it difficult to swallow frequently, and thus will drool more.
  • Hoarse voice: Irritation caused by refluxed stomach acid into the throat can lead to hoarseness.
  • Weight loss or poor weight gain: This can occur when your baby is regurgitating too much of his or her milk or formula, causing him or her to not get enough calories.
  • Frequent ear or sinus infections: This symptom, combined with the others, can help your doctor diagnose GERD.

Complications

Complications due to chronic acid reflux are uncommon in kids and teens, since many of them are related to long-term symptoms. However, it's still important to be aware of complications as a reminder of why treating GERD goes beyond just controlling symptoms. No matter your age, if you experience heartburn two or more times a week, take notice. This constant movement of acid-containing stomach contents traveling back up into your esophagus can irritate the lining and, if it's left untreated, complications can occur at any age.

Barrett's Esophagus

Barrett's esophagus is a condition in which the esophagus, the muscular tube that carries food and saliva from the mouth to the stomach, changes so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine. This acid reflux complication doesn't have any defined symptoms of its own, just the usual GERD symptoms.

People with Barrett's are 30 to 125 times more likely to develop esophageal cancer compared to those who don't have it, but fewer than 1 percent of Barrett's esophagus patients develop this cancer. Nevertheless, it is still important if you're diagnosed with Barrett's esophagus to have regular screenings—usually an upper endoscopic exam and biopsy—for precancerous and cancerous cells.

When it comes to treating Barrett's esophagus, taking the usual steps to diminish GERD symptoms, such as lifestyle, diet, and medications, will help ease the discomfort. As for reversing the disease, there are currently no medications to do that.

Esophageal Cancer

GERD is one of the risk factors for developing esophageal cancer. An esophageal cancer tumor begins growing in the esophagus lining and, if it grows enough to break through the esophageal wall, it can spread to other parts of your body using the lymphatic system as its transport.

Difficult and/or painful swallowing, hoarseness, and unexplained weight loss are symptoms of esophageal cancer. If you are experiencing any of these in conjunction with your acid reflux, talk to your gastroenterologist. There are various treatment options for esophageal cancer.

Erosive Esophagitis

When your esophagus is inflamed and swollen, it's called esophagitis. Acid reflux is the most likely cause, though an infection can also be the culprit. Symptoms of esophagitis include pain when swallowing and a burning sensation in the esophagus.

Treating esophagitis depends on the cause. Medications such as proton pump inhibitors and H2 blockers may be prescribed if the esophagitis is an acid reflux complication. Antibiotics may be prescribed if the cause of the esophagitis is an infection.

Esophageal Strictures

A complication of prolonged acid reflux can be an esophageal stricture, or a gradual narrowing of the esophagus, which can lead to swallowing difficulties. One of the causes of esophageal strictures can be scar tissue that builds up in the esophagus. When the lining of the esophagus is damaged—for example, when acid reflux occurs over an extended period of time—scarring can develop. Other causes of strictures can include infections and swallowing corrosive substances.

Respiratory Problems

Because GERD can cause you to breathe stomach acid into your lungs that can then irritate your lungs and throat, respiratory problems can occur. Some of these are both symptoms and complications and include:

  • Asthma, either new or worsening if you already have it
  • Chest congestion
  • Dry cough
  • Fluid in your lungs
  • Laryngitis or hoarseness
  • Sore throat
  • Pneumonia
  • Wheezing

Nighttime Reflux

When symptoms of gastroesophageal reflux disease (GERD) occur at night, they can be more damaging than if they occur during the day. The evening can set the stage for the following, which can make nighttime heartburn more likely to cause problems:

  • Sleeping in a supine position: Lying flat in bed allows stomach acid to flow more easily into your esophagus and stay there for longer periods of time than when you're in an upright position. Even elevating your head and shoulders six to eight inches will help keep stomach acid where it belongs.
  • The inability to drink or swallow every time an acid reflux episode occurs: When you have GERD and you're awake during an episode of acid reflux, you often will rinse your mouth or swallow some liquid. Even swallowing saliva helps. When asleep, once the refluxed acid is in your esophagus or throat, you aren't always aware of it and thus you don't take steps to rinse the acid away.
  • The increased risk of choking on refluxed stomach contents: If refluxed acid is in your throat and mouth, you can inhale this into your lungs. Once it's in your lungs, it can cause coughing and choking on this aspirated material. The acid can also cause the same damage to your lungs as it can cause when refluxed into your esophagus.

    When to See a Doctor

    If you experience frequent and/or severe heartburn, make an appointment with your doctor. If you're taking over-the-counter medication for heartburn like Prevacid, Zantac, or Prilosec, more than twice a week, you should also talk to your doctor.

    Regardless of age, see your doctor immediately if you experience any of these symptoms:

    • Vomiting large quantities
    • Persistent, forceful or projectile vomiting
    • Vomit that's green or yellow, contains blood, or looks like coffee grounds
    • Difficulty breathing after vomiting
    • Pain in your throat or mouth when you eat
    • Difficulty swallowing or painful swallowing

    Infants

    If your baby has any of the above symptoms, he or she needs to be seen by a doctor right away. Other signs that it's time to visit your doctor include:

    • Not eating and losing weight or growing poorly
    • Crying for three or more hours in a day
    • Signs of dehydration, including dry diapers

    Sources:

    Kay M, Tolia V. Common Gastrointestinal Problems in Pediatric Patients. The American College of Gastroenterology.

    Mayo Clinic. Gastroesophageal Reflux Disease (GERD). Mayo Clinic Staff. Updated March 9, 2018.

    National Institute of Diabetes and Digestive and Kidney Diseases. Acid Reflux (GER & GERD) in Infants. U.S. Department of Health and Human Services.

    National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of GER & GERD. U.S. Department of Health and Human Services. Updated November 2014.

    Vandenplas Y, Hauser B. An Updated Review on Gastro-Esophageal Reflux in Pediatrics. Expert Review in Gastroenterology and Hepatology. 2015;9(12):1511-21. doi:10.1586/17474124.2015.1093932.