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Acid Reflux Center

Signs and Symptoms of Acid Reflux Disease

author image Jonathan E. Aviv, M.D., FACS
Jonathan Aviv, M.D., is the clinical director of the Voice and Swallowing Center, ENT and Allergy Associates, and clinical professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai Hospital. He is a former professor of Otolaryngology-Head and Neck Surgery at the College of Physicians and Surgeons, Columbia University. He invented a medical device (FEESST) and authored 63 peer-reviewed articles as well as the book “Killing Me Softly From Inside.”
Signs and Symptoms of Acid Reflux Disease
Photo Credit: Getty Images

A sign generally describes something objective that other people can see or touch, such as a lump, while symptoms typically are subjective feelings experienced only by the person, such as pain or dizziness. Both types of acid reflux disease — gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) — have various signs and symptoms.

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Symptoms of Gastroesophageal Reflux Disease (GERD)

The classic symptoms of GERD are heartburn and regurgitation. Heartburn is a burning sensation in the bottom of the chest and ribcage that can extend into the middle of the chest toward the throat. Regurgitation is the sensation of food coming back up into the chest after its already been swallowed. When you hear someone say, “those yummy meatballs in red sauce I had earlier tonight keep repeating on me,” they are precisely describing the symptom of regurgitation.

Less commonly, people with GERD have upper-abdominal pain, especially in the center just below the ribs. Nausea, periodic burping, feeling bloated or having difficulty with swallowing can also indicate GERD.

Signs of Gastroesophageal Reflux Disease (GERD)

Because the problems with GERD are all happening on the inside of the body, there are no outward signs that a doctor or other person can observe. The typical signs of GERD can be seen with an endoscope, which is a thin, flexible camera placed through the mouth or nose to examine the throat, esophagus, stomach and duodenum. GERD causes signs of inflammation in the esophagus, such as redness, swelling or breaks in the lining of the esophagus known as erosions or ulcers. When GERD is severe, the lining of the lower part of the esophagus begins to look like the lining of the stomach, a condition called Barrett’s esophagus.

Symptoms of Laryngopharyngeal Reflux Disease (LPRD)

Unlike GERD, the symptoms of LPRD generally have nothing to do with the stomach or lower esophagus. When acidic stomach contents travel beyond the esophagus all the way up to the throat, people with LPRD typically notice such symptoms as chronic coughing, frequent throat clearing, hoarseness, a lump-like sensation in the throat, sore throat or even postnasal drip.

Some people with acid reflux disease have both GERD and LPRD symptoms, but most people with LPRD have little or no heartburn. That’s why you may hear the term silent reflux used to describe LPRD, referring to acid reflux disease without heartburn. However, there is nothing silent about coughing, throat clearing and a raspy voice.

LPRD symptoms may be thought of as alarm symptoms indicating the possible presence of long-term esophageal inflammation. In individuals with acid reflux that has been going on for a long time, the injury caused by chronic acid exposure can result in the esophagus becoming relatively numb, so heartburn is no longer felt, although symptoms persist in the throat. This is why your doctor may examine both your throat and your esophagus if you have LPRD symptoms.

Signs of Laryngopharyngeal Reflux Disease (LPRD)

To diagnose LPRD, a doctor must examine the throat and larynx area with special instruments, such as an endoscope. LPRD produces swelling, which is often most noticeable in the larynx (the voice box where the vocal cords are located).

Normally, the vocal cords are thin, delicate vibrating structures as narrow as violin strings. When viewed through an endoscope, swollen vocal cords can look like fat cigars causing the voice to sound raspy.

Reflux Symptoms and Serious Other Diseases

Sometimes symptoms that appear to be due to GERD or LPRD are actually the result of other conditions that can be very serious. Heartburn can sometimes be confused with chest pain due to other disorders, including heart disease. Although chest pain from a heart attack or angina — transient chest pain caused by decreased blood flow to the heart — is typically more like a squeezing or pressure sensation, it can sometimes be similar to heartburn. Lung cancer may also cause chest pain, although it usually occurs on just one side of the chest.

Similarly, a long-standing cough can be a symptom of cancer of the lungs, especially in people who smoke, or a chronic lung infection like tuberculosis. Hoarseness, sore throat or a sensation of something in the throat may be caused by cancer in the throat or larynx.

When to Seek Medical Attention

Seek immediate attention if you have chest pain that is not relieved by anti-GERD medication like antacids, especially if it is accompanied by shortness of breath, nausea, sweating or lightheadedness. Also see a doctor if you have chest pain that occurs frequently or persists for a few weeks. Coughing, frequent throat clearing, hoarseness, a lump-like sensation in the throat, sore throat or postnasal drip that lasts for more than eight weeks should also be assessed by a doctor.

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