Six signs and symptoms of acid reflux

Acid reflux, also known as gastro-oesophageal reflux, occurs when acid in your stomach flows back into the lower or middle part of your gullet (oesophagus), which is a muscular tube that connects your throat to your stomach. 

Here, we will look at six signs and symptoms of acid reflux, as well as how it is diagnosed and treated. 

Why does acid reflux happen?

Acid reflux occurs due to weakness in a ring of muscle called the lower oesophageal sphincter, which prevents the sphincter from closing properly. 

This sphincter is found where your oesophagus meets your stomach and acts as a valve to prevent acid and food in your stomach from rising back up into your oesophagus. 

Most people will experience occasional acid reflux at some point, usually triggered by eating spicy and/or fatty food or drinking fizzy and/or caffeinated drinks. The symptoms of occasional reflux are most often mild and resolve in a few minutes or hours. 

However, if you experience acid reflux more than two to three times a week, with each episode lasting longer than five minutes, and have more severe symptoms, you may have acid reflux disease.

Acid reflux signs and symptoms

1. Heartburn 

This refers to a burning sensation in your upper chest and is the most common symptom of acid reflux. Heartburn usually occurs after eating a large, spicy and/or fatty meal. 

2. Regurgitation

This occurs when acid, partially digested food and/or bile from your stomach passes into your oesophagus and then your throat and back of your mouth. You may feel a burning sensation at the back of your throat and a bitter taste in your mouth. 

3. Chest pain

Heartburn can cause non-cardiac chest pain ie chest pain that is not due to any heart condition. This type of chest pain usually occurs behind your breastbone (sternum) and/or in the area just below it (epigastrum).

Unlike chest pain caused by angina or another heart problem, chest pain due to heartburn doesn’t usually spread to other parts of your body, such as your arms, neck, shoulders and back. 

Acid reflux can also lead to chest pain due to the damage it can cause to your oesophagus — this results in the spasm of the wall of your oesophagus. 

4. A persistent cough

Frequent irritation of your oesophagus caused by acid reflux can cause a chronic (long-term) cough, as well as wheezing and in some cases, difficulty breathing. 

This is most likely due to small amounts of stomach acid that have passed into your oesophagus and escaped through your upper oesophageal sphincter ie the ring of muscle at the top of your oesophagus. These tiny droplets of acid can then irritate your voice box (larynx) and/or the branches of your airways. 

5. Hoarse voice

As mentioned earlier, small amounts of stomach acid that escape your stomach can enter and irritate your larynx. This can cause a hoarse voice, especially in the mornings as stomach acid is more likely to escape from your stomach during the night when you are lying down flat. Hoarseness usually improves as the day progresses. 

6. Difficulty swallowing

Repeated bouts of acid reflux can cause chronic inflammation of the lower part of your oesophagus, leading to scar tissue that narrows your oesophagus. This can make it more difficult to swallow. 

Difficulty swallowing (dysphagia) can also be due to a hiatus hernia, which is a known cause of acid reflux. A hiatus hernia occurs when part of your stomach protrudes into your chest area via your oesophagus, which passes through your diaphragm. 

What is laryngopharyngeal reflux and what are its symptoms?

Laryngopharyngeal reflux differs from gastro-oesophageal reflux as it occurs when acid from your stomach passes into your larynx. It doesn’t cause typical reflux symptoms, such as heartburn; consequently, it is often called silent reflux. 

Instead, laryngopharyngeal reflux causes changes in your voice, a persistent dry cough and sore throat, excess mucus gathering and dripping down the back of your throat (postnasal drip), and the sensation of a lump in your throat (globus sensation). 

Getting a diagnosis of acid reflux

Your doctor will ask you about your symptoms, including how often they occur and for how long, as well as potential triggers eg do your symptoms usually occur straight after a meal or after drinking certain beverages?

Based on your symptoms, they may then recommend a gastroscopy, where a thin, flexible telescope-like tube with a camera on the end (a gastroscope) is passed through your mouth and into your oesophagus. This will allow your doctor to look at your oesophageal sphincter and if needed, collect tissue samples. 

You may need further investigations to confirm your diagnosis, such as oesophageal pH monitoring and manometry to measure the pH levels (acid levels) and pressure in your oesophagus, respectively. pH monitoring is performed by inserting a thin tube (catheter) with a sensor attached via your nose into your oesophagus. This will be in place for 24 hours during which time the sensor will collect pH measurements. 

Manometry is performed in a similar way with a catheter inserted via your nose into your oesophagus. You will be asked to swallow a liquid and pressure measurements will be collected to check how well the muscles of your oesophagus and lower oesophageal sphincter are working. This test takes 30–45 minutes. 

Finally, your doctor may recommend a barium swallow test, where you will be asked to drink a barium solution, after which X-ray images will be taken to check for any structural abnormalities in your gastrointestinal tract. 

Acid reflux treatments

Treatment for acid reflux starts with making lifestyle changes, such as avoiding foods and drinks that trigger your acid reflux (eg spicy and fatty foods, and caffeine), quitting smoking, reducing how much alcohol you drink, eating frequent but small meals, avoiding eating late at night, and elevating your head when sleeping. 

It is also important to maintain a healthy weight, as being overweight or obese increases your risk of complications due to acid reflux. 

If lifestyle changes aren’t enough to manage your symptoms, you can try over-the-counter remedies, such as reflux suppressants. These can help neutralise your stomach acid or prevent it from escaping into your oesophagus by coating your stomach contents with a protective layer.

If these approaches aren’t effective, your doctor can prescribe antacid medications, such as proton pump inhibitors and H2 receptor blockers, which reduce the amount of acid produced by your stomach. 

In severe cases, where lifestyle changes and medication together are not effective, your doctor may recommend surgery or a minimally invasive endoscopy procedure.