Symptoms of Gastroesophageal Reflux Disease (GERD)

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

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.

Symptoms in the Elderly

Elderly patients may not connect their symptoms with heartburn or GERD, as they may be different from what is considered typical for 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. These individuals also tend to have decreased saliva production—problematic, as saliva's alkaline nature can help neutralize acid. Saliva can also relieve heartburn by bathing the esophagus, helping to protect it from the effects of acid that is refluxed and washing it back down to the stomach.

Less Common Symptoms

These symptoms are certainly not as common as those above, but it's worth being aware of them so you can bring them to your doctor's attention if they occur. You might not necessarily associate them with GERD.

  • 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, chronic cough, and other pulmonary diseases. 
  • Hoarse voice: Irritation caused by refluxed stomach acid into the throat is a frequent cause of chronic hoarseness (laryngitis) in adults.

Complications

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
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