How To Know If You Have Acid Reflux
How To Know If You Have Acid Reflux
Acid reflux causes a TON of symptoms all over the body. Its effects are so widespread that it is often confused with other health problems to the point that doctors can struggle to make a clear diagnosis.
This guide will help you figure out if your symptoms are coming from acid reflux - and when you should go to a doctor for further diagnosis.
We'll cover:
Common symptoms of acid reflux
Uncommon symptoms of acid reflux
Symptoms of 'silent reflux'
When to see a doctor
At-Home Tests to identify acid reflux
Often mistaken diagnosis to rule out
FAQ at the end
Common symptoms of acid reflux
Acid reflux happens when stomach contents flows backward into the esophagus. Reflux can affect each part of your esophagus differently. Some people have issues stemming only from their lower esophagus, some people's reflux only bothers their upper esophagus and airways, and some unlucky souls have to deal with both. Occasional episodes are considered normal, but if you experience reflux at least weekly it is considered GERD (Gastroesophageal Reflux Disease) which is like chronic acid reflux.
'Hallmark' symptoms of acid reflux:
Heartburn: A burning sensation in the chest or throat, often worse after eating, lying down, or bending over
Regurgitation: A feeling of stomach contents coming back up into the mouth or throat. GERD is the most common cause of regurgitation in adults¹. It's different from vomiting. Regurgitation is effortless and involuntary backward flow of stomach contents, so there's no retching, forceful abdominal contractions, or nausea. The material can be undigested food, tasteless fluid containing mucus, or a sour/bitter-tasting acidic liquid, depending on how long it has been in the stomach. Those experiencing regurgitation will often report a sour taste in the mouth often accompanied by bad breath. They also report a feeling of fluid moving up and down in the chest. Approximately 80% of GERD cases involve regurgitation of varying degrees of severity².
Other common symptoms:
Globus sensation: A feeling of a lump in the back of the throat. This is different from difficulty swallowing (dysphagia). Reflux is one of the major causes of globus sensation, with one study finding 23-68% of people's globus sensation was due to reflux³. Other common causes include stress/anxiety and various inflammation issues like chronic sinusitis.
Chronic cough: GERD is the third leading cause for chronic cough, though coughing could technically be considered a symptom of LPR. Acid reflux is the cause in 20% of chronic cough cases, with only sinus problems and asthma topping it⁴. Chronic cough can also be your only symptom of acid reflux. When GERD causes cough, 75% of the time there are no other GI symptoms⁵. If your cough is unexplained after testing for common respiratory issues like post-nasal drip, asthma, and other respiratory causes, the likely cause is acid reflux⁶.
Dysphagia: Trouble swallowing of varying in severity. It could be a sensation of food sticking in the chest or not going down the esophagus easily or even just an abnormal awareness of food passing through the esophagus. It is usually due to increased sensitivity of the esophagus but can also come from more severe damage like a stricture⁷.
Non-cardiac chest pain: A very common symptom of acid reflux, with 34% of reflux cases reporting the symptom absent any heart issues⁸. It is estimated that the prevalence of GERD in those with undiagnosed chest pain is estimated to be greater than 50%⁹. Acid reflux is a very common cause of non-specific chest pain.
Burping: Acid reflux can cause increased belching by promoting more swallowing to deal with any discomfort¹⁰. Understandably, numbers on this vary widely. One study of 100 people with excessive belching (usually defined as 3 burps per meal, or burping happening more than 3 times per week) found that 41 of them had acid reflux¹¹. Studies find between 4-75% of GERD cases list burping as a symptom¹².
Dental erosion: Damage to the tooth enamel is relatively common in people with GERD, with one study finding 95% of GERD patients having dental erosion¹³. In silent reflux, dental erosion may be the only sign you are having reflux¹⁴. However, there are many other causes of dental erosion, including consumption of acidic foods and drinks, dry mouth, and tooth grinding.
Less common:
Nausea: A feeling of sickness or queasiness, like you're going to throw up. Around 1 in 5 people with acid reflux report nausea¹⁵. Nausea that persists for weeks or even months has many potential causes like stomach ulcers, gastritis, constipation, stomach cancer, pancreas or gallbladder issues, or prescriptions, to name a few. Your nausea could be caused by acid reflux alone, in combination with one of these issues, or independent of the reflux altogether.
Bloating: A feeling of fullness or tightness in the stomach. While 48% of GERD patients report bloating¹⁶, I've listed it as Less Common because acid reflux itself does not cause bloating. However, acid reflux and bloating share many underlying triggers and overlapping conditions. Shared triggers include certain foods, eating habits, and swallowing air. Overlapping conditions include things like IBS and SIBO.
Hiccups: Stomach acid irritating the diaphragm and esophageal nerves can trigger diaphragm spasms, causing hiccups. These spasms can unfortunately start a cycle where more spasms lead to more reflux, which can lead to more symptoms. An estimated 10% of GERD patients report hiccups¹⁷. Acute hiccups (lasting less than 48 hours) is generally considered no big deal but if it lasts more than 48 hours it is considered persistent hiccups. 80% of cases of persistent hiccups are caused by GERD¹⁸, so if your hiccups are lasting more than 2 days, it is likely due to reflux.
Uncommon Symptoms
These symptoms usually indicate more severe reflux or reflux complications:
Vomiting: considered an atypical symptom of GERD, but it does happen for some people. It usually occurs due to other symptoms of nausea. There are many other things that can cause vomiting, including infections like gastroenteritis, food poisoning, and pregnancy (morning sickness). Other triggers include medication side effects, motion sickness, severe pain, migraines, and even psychological factors like stress or unpleasant sights or smells.
Bloody stools: In severe, chronic acid reflux, inflammation and bleeding in the esophagus can lead to blood in stool. An estimated 8% of people with GERD have this symptom¹⁹. There are many more common causes to bloody stool, including other gut issues like diverticulitis, stomach ulcers, Inflammatory Bowel Disease, anal fissures, hemorrhoids, to name a few.
Loss of appetite: Feeling full or uninterested in eating. Usually due to complications associated with chronic reflux disease²⁰, or repeated discomfort after eating.
Silent Reflux Symptoms
Acid reflux can also cause upper respiratory issues. This happens when stomach juices travel up into the throat, and mouth either in full regurgitated fluid form or in particle form.
Acid reflux is a surprisingly common cause of respiratory issues. As a reference point for how common this really is, acid reflux is the third most common cause of chronic cough, and 10% of referrals to the ear, nose, and throat doctor wind up being acid reflux cases²¹ (crazy since we can assume a GP has already diagnosed the obvious cases).
When reflux only affects the upper respiratory area, doctors give it another name: Laryngopharyngeal Reflux or LPR. You can think of GERD as the collection of symptoms related to the irritation and damage of the lower esophagus (i.e. the symptoms we discussed above) and LPR as the group of symptoms around the throat and mouth. Even though we have different terms for each, they share the same fundamental cause of reflux and thus have some overlap in symptoms.
Important! You can have GERD... you can have LPR... or you can have both GERD and LPR. Where this is really important is understanding that you can absolutely have upper respiratory issues from reflux WITHOUT the presence of heartburn, chest pain, etc. To give you context, when acid reflux causes a chronic cough, 75% of the time there are no other symptoms. That's why LPR is often called "silent reflux".
So here's the symptoms of LPR and/or silent reflux:
Chronic cough: As stated in the GERD section above, coughing, especially chronic coughing, is often caused by reflux, though reflux is not the most common cause. 20% of chronic cough cases are due to LPR²². In the case of LPR, the cough tends to be dry and irritating, worse after meals or when lying down, and doesn't respond to typical cough medications²³.
Chronic Sore Throat: Irritation of the throat by stomach acid. Sore throat is usually due to viral or bacterial infection, allergies, or environmental irritants²⁴. However, if it is chronic and lasts 6+ weeks, it is very likely to be caused by acid reflux. One study found that acid reflux was the cause of difficult-to-treat sore throat and laryngitis in as many as 60% of patients²⁵.
Hoarseness: A change in voice and/or lowering of your voice register due to acid irritation. This often occurs in the morning, with people describing a roughness, difficulty to project, or noticing their voice gives out. The morning effect is because reflux is typically worse when lying down, and in the morning you have been lying down all night! Healthcare providers estimate that over half of people who complain of chronic hoarseness have LPR²⁶.
Laryngitis: Inflammation of your vocal cords or losing your voice. One of the symptoms of laryngitis is hoarseness, so they are very related. LPR is the most common cause of chronic laryngitis, being responsible for an estimated 30% of chronic cases²⁷. If your laryngitis is acute (usually a week or less), it is most likely due to viral or bacterial infection or overuse.
Globus Sensation: Sensation of a lump in the throat or something stuck in your throat. People often report a feeling of a golf ball stuck in their throat, or like they've been wearing a too-tight necktie all day.
Difficulty Swallowing: Feeling that food gets stuck or slowed while going down your food pipe. Reflux is the most common cause for difficulty swallowing²⁸ (dysphagia). This usually happens due to strictures, or narrowing of the esophagus, which happen as a result of chronic damage from contact with stomach juices.
Asthma-like symptoms: Respiratory issues such as wheezing and shortness of breath. LPR is a major cause of asthma and is often co-existent with asthma, especially in difficult-to-treat adult onset asthma. One study in a community healthcare setting showed LPR was the direct cause or occurred alongside asthma in 62% of patients²⁹. Allergies are still the most commonly cited risk factor for asthma, with an estimated 60% of people with asthma having allergies³⁰.
Postnasal drip: Excessive mucus or phlegm. Somewhere around 75% of LPR cases have this symptom³¹. It happens because your throat produces the mucus as a protective barrier against the acid coming up the esophagus.
Sore Throat: Chronic sore throat that is difficult to treat or persists for more than 3 months is often due to acid reflux. One study found that 72% of patients admitted for chronic sore throat had LPR³².
Throat clearing: Having to clear one's throat due to irritation or excess mucus. This is the most common symptom of LPR³³. As acid irritates and inflames your throat, clearing your throat is a natural response to attempt to fix the irritation. However, it's kind of like scratching a mosquito bite - the more you scratch, the worse it gets. More throat clearing creates micro-trauma, bringing more inflammation and additional mucus to protect the area, which again brings more throat clearing and coughing. Studies show that maybe 70-87% of people with LPR have this symptom³⁴,³⁵.
Frequent upper respiratory infections: Frequent or persistent sinus and ear infections. Acid exposure can cause nasal and sinus passages to inflame and swell, blocking proper drainage of mucus, on top of potential excess mucus production to protect against acid. This mucus backup is a great breeding ground for bacteria and infection.
When To See A Doctor
It is worth briefly noting that if you are experiencing any of the following symptoms, you should seek help from a doctor.
Vomiting
Bleeding or anemia
Abdominal mass or weight loss
Dysphagia
You can remember these symptoms by the acronym VBAD³⁶ VBAD. They are alarm symptoms that may prompt further investigation by endoscopy, looking for severe damage and/or cancer.
Tests To Identify Acid Reflux
If I'm being honest, even doctors often have difficulty diagnosing reflux because there are so many symptoms that overlap with other health issues. I think it is telling that one of the most common ways they arrive at an official diagnosis is by prescribing acid-suppressing medication and waiting for a couple months to see if it works. You can check out the decision tree for LPR diagnosis here if you want a visual for how complicated it often gets.
There's still a lot you can do to narrow it down for yourself. Here's some big indicators that your symptoms are acid reflux causing GERD:
Symptoms usually occur within 30 min - 2 hours after meals, especially big or heavy meals. If you get symptoms when your stomach is full and releasing juices to digest food, this is a big sign your problem is from acid reflux. However some LPR symptoms can happen independent of mealtimes - people report chronic cough throughout the day, not just after they eat.
Symptoms worse when you lie down, bend over, or lift something. When standing up, gravity can help you keep stomach contents in the stomach. Laying down or bending over changes that and makes it easier for acid to escape the stomach. This said, it's only a rough rule of thumb because some people report more symptoms when standing vs prostrated. Lifting is an indicator because you tense your abdominal muscles when lifting. This strain puts more pressure on the stomach, encouraging more reflux.
Symptoms subside with reflux medication. Of course, we'd like to be able to know the problem before we pop pills, but with something as sneaky as reflux can be, you might have to take a page out of your doctor's book and treat it like it's reflux unless proven otherwise. You could start with a basic antacid and then progress to an over-the-counter H2 Blocker or PPI. I wrote a bit more about these meds and their risks in my comprehensive reflux guide, available here. Please keep in mind they are not meant for prolonged use and do have other drug interactions, so read the labels! Always ask your doctor before starting a medication.
Conditions to Rule Out
You can also be more sure if you can rule out other issues, so let's talk about some things acid reflux is commonly misdiagnosed as. This is not an exhaustive list:
Dyspepsia is the most commonly confused disorder with acid reflux. Dyspepsia isn't really a condition, but more a syndrome, or a pattern of symptoms that occur together. These symptoms are nausea, bloating, upper abdominal pain or discomfort, and fullness after eating (especially early in the meal). It is sort of a catch-all often diagnosed when a healthcare provider can't find a direct cause for your symptoms³⁷. To figure out if your symptoms are due to acid reflux, first consider if you have regurgitation, since dyspepsia does not have that. If you have pain, see if your pain is concentrated more on the stomach (your left side bottom rib cage area) or your lower esophagus (more behind the sternum) which would indicate reflux. Pain in dyspepsia doesn't have to occur during mealtimes, whereas acid reflux would tend to cause symptoms 30 minutes to 2 hours after eating.
Angina/Cardiac Related Chest Pain is also commonly confused with acid reflux. We've already discussed studies that show a large amount of ER visits for chest pain are actually GERD, and the two are often confused because both can occur after a large or heavy meal. In general, assuming you do not already have risk factors for or diagnosed with heart disease, the pain is more likely due to acid reflux if it worse at night (when you lay down) and does not occur after exercise³⁸. Your chest pain can also be caused by both reflux and heart issues at the same time.
Other causes of esophagus irritation that would lead to similar symptoms to acid reflux include infections such as Candida and other fungi or yeast and viruses such as herpes or cytomegalovirus. Allergic or immune problems of the esophagus are also possible³⁹.
Other gastrointestinal issues can have some overlap with GERD issues, however, you would usually have other symptoms that would make it pretty easy to tell.
Cool, well that's about as far as I can take you without evaluating your case directly. If you think you have acid reflux, I recommend you download my Ultimate Guide To Acid Reflux for a complete approach for long-term relief.
I will now go into an FAQ on acid reflux symptoms, as one can never be too thorough when writing for the internet :)
Frequently Asked Questions
Can acid reflux cause chest pain?
Yes, acid reflux is a common cause of chest pain. Some people experience this pain as heartburn, but reflux can also cause 'non-specific' chest pain. This is probably because the esophagus has a lot of nerves and connectivity to other parts of the chest, and it runs through the whole chest cavity, so inflammation there can reasonably lead to pain in the chest in general.
To give you an idea of how common chest pain is cause by acid reflux, research shows that up to 50% of chest pain cases are due to causes dominated by acid reflux⁴⁰,⁴¹,⁴². You can get some tips to figure out if your chest pain is due to heart or reflux issues in the section just above this FAQ called "Conditions To Rule Out".
Can acid reflux cause nausea?
Yes, acid reflux can cause nausea, but it is one of the less common symptoms and nausea absent other reflux symptoms is more often a sign of other health issues. To give you a reference point, around 1 in 5 people with acid reflux report nausea¹⁵. Nausea that persists for weeks or even months has many potential causes like stomach ulcers, gastritis, constipation, stomach cancer, pancreas or gallbladder issues, or prescriptions, to name a few. So if you already have GERD, chronic nausea could be the newest symptom of the reflux, it could be a new problem, or in combination with another issue.
Can acid reflux cause coughing?
Yes, acid reflux is the third most common cause of chronic coughing, behind sinus problems and asthma. People with GERD appear to have an above-average risk for chronic bronchitis, chronic sinusitis, emphysema, pulmonary fibrosis (lung scarring), and recurrent pneumonia⁴³. This is due to the potential for acid and digestive material to travel to the upper esophagus where it can irritate tissues in the throat and voice box and even introduce bacteria to be inhaled into the lung airways. If your cough occurs absent any allergy or asthma issues, reflux is a likely culprit. Keep in mind it is relatively common to have respiratory issues from acid reflux without the hallmark reflux symptoms of heartburn or regurgitation. You might evaluate more of the symptoms above or consider some telltale signs of acid reflux in the "Tests To Identify Acid Reflux" section above.
Can acid reflux cause shortness of breath?
Yes, acid reflux can cause shortness of breath, as well as other asthma symptoms like wheezing and coughing. This happens when stomach acid travels up the esophagus and is partly inhaled into the lungs, where it irritates the tissues and can constrict airways. You can also have shortness of breath from acid reflux without heartburn, in which case it is commonly referred to as "silent reflux". Check the lists of symptoms above for more information.
Can acid reflux cause diarrhea?
Acid reflux does not cause diarrhea directly, however it is often seen alongside other digestive issues that cause diarrhea, such as SIBO or IBS. Some drugs used to treat acid reflux can cause diarrhea but it is uncommon⁴⁴.
Can acid reflux cause sore throat?
Yes, acid reflux can cause sore throat, especially chronic sore throat that is difficult to treat. This happens when stomach contents backflows to the throat and irritates and inflames those tissues. If you can rule out viral or bacterial infection, environmental irritants like smoking, dry air, allergies, and air pollution, it may be acid reflux. Again, the chronic nature is important because infections will go away eventually or antibiotics will knock them out, but if it keeps happening and drugs aren't effective, then it becomes way more likely that reflux is to blame. You can line up other symptoms using the article above.
Can acid reflux cause vomiting?
Acid reflux can cause vomiting, but it's rare. Regurgitation is the more common symptom, which is different than vomiting because it's involuntary and happens without retching or forcible contraction of the abdomen. In rare cases, vomiting from acid reflux can occur as often as once a day. You should rule out all other common causes of nausea and vomiting first, including ulcers, stomach cancer, obstruction, and pancreas or gallbladder disorders⁴⁵.
Can acid reflux cause stomach pain?
Acid reflux can cause upper abdominal pain. It does not affect the stomach itself, but rather the lower esophagus which connected to the stomach, sometimes making it difficult to tell if it's true stomach pain or acid reflux pain. Typically, acid reflux pain is more around your centerline and even behind the sternum. The sensation can be anywhere from a dull ache to a sharp pain or burning feeling. Abdominal pain can also indicate infection, stomach ulcers, constipation, gastritis, pancreas or gallbladder issues, cancer, or more, so make sure you use the article above to evaluate how reflux might play a role in your situation.
Will acid reflux go away?
Acid reflux usually goes away after a couple hours. Occasional episodes (i.e. like once or twice a year) are considered normal with nearly half of survey respondents in one study reporting regurgitation in the past year⁴⁶. However, if it comes back on a weekly basis or more, it is considered GERD (Gastro-Esophageal Reflux Disease). Like other lifestyle diseases, if the underlying causes are left untreated, it will not go away and instead tend to get more frequent and more severe over time.
How does acid reflux feel?
The hallmark of acid reflux is heartburn (a dull or sharp pain in the chest, often burning sensation, usually behind the sternum or lower left rib cage) and/or regurgitation (non-forced backflow from the stomach up the food pipe, sometimes all the way to the throat and mouth, that feels like fluid moving through the middle of your chest). Other clues you have reflux are in the symptoms listed above in this article.
Citations
National Institutes of Health - GERD is the most common cause of regurgitation in adults
National Institutes of Health - Approximately 80% of GERD cases involve regurgitation
National Institutes of Health - 23-68% of people's globus sensation was due to reflux
Clinical Gastroenterology and Hepatology - Acid reflux causes 20% of chronic cough cases
National Institutes of Health - When GERD causes cough, 75% of the time there are no other GI symptoms
American Family Physician Journal - Unexplained cough is likely acid reflux
National Institutes of Health - Description of dysphagia
World Journal of Gastroenterology - 34% of reflux cases report chest pain without heart issues
National Institutes of Health - Prevalence of GERD in undiagnosed chest pain is estimated >50%
Mayo Clinic - Acid reflux increases belching through more swallowing to deal with discomfort
Journal of Neurogastroenterology and Motility - 41% of excessive belching cases had acid reflux
National Institutes of Health - 4-75% of GERD cases list burping as a symptom
Journal of Indian Association of Public Health Dentistry - 95% of GERD patients have dental erosion
British Dental Journal - Dental erosion may be the only sign you are having reflux
Clinical Gastroenterology and Hepatology - Around 1 in 5 people with acid reflux report nausea
Diseases of the Esophagus - 48% of GERD patients report bloating
National Institutes of Health - An estimated 10% of GERD patients report hiccups
UCLA Health - 80% of cases of persistent hiccups are caused by GERD
Cincinnati GI - An estimated 8% of people with GERD have blood in their stool
Medical News Today - Loss of appetite points to complications of GERD
Clinical Gastroenterology and Hepatology -10% of referrals to ENT are acid reflux cases
Frontiers in Medicine - 20% of chronic cough cases are due to LPR
Sleep and Sinus Centers of Georgia - Characteristics of LPR-caused cough
Clinical Gastroenterology and Hepatology - Usual causes of sore throat
Clinical Gastroenterology and Hepatology - Acid reflux caused laryngitis in 60% of patients
Cleveland Clinic - Over half of people who complain of chronic hoarseness have LPR
The Journal of International Medical Sciences Academy - LPR causes 30% of chronic laryngitis cases
Lakeshore Ear Nose and Throat Center - Reflux is the most common cause for dysphagia
The Journal of Allergy and Clinical Immunology - LPR involved in 62% of asthma patients
Cleveland Clinic - 60% of people with asthma having allergies
National Institutes of Health - ~75% of LPR cases have excessive mucus
National Institutes of Health - 72% of patients admitted for chronic sore throat had LPR
Mount Sinai - Throat clearing is the most common symptom of LPR
Sleep and Sinus Centers of Georgia - 70 of people with LPR have throat clearing symptom
National Institutes of Health - 87% of people with LPR have throat clearing symptom
National Institutes of Health - VBAD acronym
Cleveland Clinic - Dyspepsia a diagnosis when doctor can't find a direct cause for symptoms
Mount Sinai - Indicators that chest pain is more likely acid reflux
Mount Sinai - Other causes of acid reflux symptoms that wouldn't be reflux related
UpToDate - 10-50% of chest pain cases have a gastrointestinal cause dominated by (GERD)
UpToDate - ~50% of recurrent noncardiac chest pain patients have abnormal acid exposure
National Institutes of Health - Prevalence of GERD in those with undiagnosed chest pain is >50%
Mount Sinai - People with GERD greater risk for various upper respiratory diseases
Medline Plus - Some drugs used to treat acid reflux can cause diarrhea but it is uncommon
Mount Sinai - In rare cases, vomiting from acid reflux can occur as often as once a day
National Institutes of Health - Nearly half on a survey reported regurgitation in the past year
