There it is again: That painful, fiery sensation rising up into your chest and throat. Your mind jumps to that greasy piece of pizza you instantly regret eating—and you know the acid reflux it spurred is about to burn.
Acid reflux—a condition in which your stomach's acids bubble up into your esophagus and throat—is extremely common. If you experience acid reflux every once in a while, it's simply known as gastroesophageal reflux (GER). But if you deal with it on a chronic basis (two days or more per week), that's when it's diagnosed as gastroesophageal reflux disease (GERD), per the U.S. National Library of Medicine.
Those powerful stomach acids are pretty necessary, as they help break down the foods you eat, setting off the digestion process. The problem arises when those acids don't stay where they should, which is most common for reflux sufferers after large meals and during bedtime. The likely culprit? A weak or relaxed lower esophageal sphincter, when the tiny valve at the base of your esophagus opens when it's not supposed to, allowing stomach acid to slosh its way up, per the National Institutes of Health (NIH).
Lots of things can up your risk of acid reflux, per the American Gastroenterological Association (AGA), including obesity, pregnancy, smoking, alcohol, age, certain medications, or having a hiatal hernia. But most people find that particular foods can be a huge reflux trigger. Think: fried and fatty foods, chocolate, tomato sauce, alcohol, coffee, carbonated drinks, and vinegar.
Acid reflux doesn't always have noticeable symptoms, but almost all of us experience it from time to time in the form of heartburn. But reflux can cause less obvious symptoms, too, says Joseph Murray, M.D., a gastroenterologist who researches esophageal disorders at Mayo Clinic. The condition can be complicated, and it is not always the answer to related health issues or that weird feeling in the throat. "I also see reflux being blamed for symptoms that have nothing to do with it," Dr. Murray says.
Not sure what you're dealing with? Ahead, the most common (and unusual) signs of acid reflux that go way beyond bouts of heartburn.
Chest pain, especially after eating
Yes, it's a cliché that people mistake heartburn for a heart attack—but there is truth to it. "It's not uncommon to see someone in the ER with terrible chest pain, thinking it's a heart attack, when it's actually reflux," Dr. Murray says.
The opposite also happens—sometimes with tragic results. "Someone is having a heart attack, but they don't go to the ER because they figure it's indigestion," he says.
Typical heart attack symptoms will include tightness or pressure in the chest, arms, or neck, which doesn't occur with reflux or GERD, per Mayo Clinic. When in doubt, go to the emergency room.
If your mouth is flooded with saliva after a meal or snack, that's often a good indicator of acid reflux, Dr. Murray says. For some of the same reasons your mouth starts watering before you vomit, your salivary glands kick into high gear when they detect an irritant in your throat. They're preparing to wash away whatever's down there—or about to come up.
Breathing issues or wheezing
If you experience problems breathing, especially if this feels worse at night when you're laying in bed, reflux may be to blame.
"When you lie down, acid washing up into the esophagus can trigger a reflex that causes wheezing," Murray explains. "The acid can also go into airways and cause direct irritation, so you could be waking up choking and coughing."
Another sign of reflux, per the AGA, is the feeling of food coming back up after you've eaten. It's not the same as throwing up—it's more like that strange sensation that something is creeping up your throat to the back of your mouth.
The stomach juices or fluids that force their way up into your esophagus can also leave a sour or acidic taste in the back of your throat, according to Mayo Clinic research in the American Journal of Medicine. If eating seems to spur a bitter taste in your mouth, acid reflux may be the culprit.
A sensation of a lump in the throat
The AGA explains that the constant feeling of a lump in your throat (known as globus sensation) could actually be a sign of chronic reflux, especially when combined with other symptoms on this list. However, it's not always a symptom of reflux, Dr. Murray says, and "dust or irritants" could be to blame for that lump feeling or constant throat-clearing.
Like regurgitation, frequent burping is a sign that food could be making its way back up your esophagus, per the AGA. Chronic belching also might be caused by increased swallowing associated with GERD, according to Mayo Clinic.
Difficult or painful swallowing
"Reflux can cause a narrowing of the throat due to damage and scarring, so food is actually being held up on its way down," Dr. Murray says. This can feel like your food has grown claws and is scratching at your throat as it heads toward your stomach, so swallowing feels much more painful or difficult than it should be.
It makes sense that reflux would cause nausea, per the NIH, since the condition is rooted within your digestive system. Chronic nausea is not necessarily related to acid reflux, but it is one of the more common signs.
A sore throat, coughing, and hoarseness can be caused by a condition called laryngopharyngeal reflux, which happens when stomach acid reaches the throat. Dr. Murray recommends caution before automatically assuming your throat troubles are the result of reflux, however: "Too often, a doctor sees a red throat and starts treating it with heavy-duty acid-blocking drugs," he says. If you try those drugs for two weeks and don't notice an improvement, "something else may be going on," like allergies or a sinus infection.
When to see your doctor about acid reflux
Although acid reflux is not life-threatening, some symptoms could be signs that the condition has become chronic, meaning your risk of complications can increase. When stomach acids escape your belly, they don't just irritate your throat. They can also make their way into your lungs. If that happens, you can end up with "a nasty case of pneumonia," Dr. Murray explains. What's more, people who have GERD also have a slightly higher esophageal cancer risk.
Talk to your doctor if you experience a loss of appetite, persistent vomiting, problems swallowing, unexplained weight loss, vomit that looks like coffee grounds, or bloody or black stools, per the NIH. (The last two symptoms are signs of bleeding in the digestive tract.)
Chest pain can signal heart trouble, meaning you should also seek immediate medical attention if you suspect you may be having a heart attack—especially if the pain comes on with physical activity, according to the AGA.
Acid reflux can also have a big impact on your quality of life, even without potentially dangerous complications. Cutting out trigger foods and taking over-the-counter antacids might be enough to quiet down your unruly stomach acids, but you can always talk to your doctor to find the best treatment plan for you.
If your symptoms don't improve with lifestyle changes or after you try over-the-counter medications, your doctor will be able to help you with next steps, including prescription-strength options like proton-pump inhibitors.
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