Acid Reflux Symptoms
The primary symptoms of acid reflux are heartburn (a substernal burning sensation in the chest) and regurgitation, which occur in the majority of patients with gastroesophageal reflux disease (GERD). 1
Typical (Esophageal) Symptoms
The classic presentation of GERD includes:
- Heartburn: A substernal burning sensation rising from the stomach toward the throat, which is the most commonly recognized manifestation of GERD 1
- Regurgitation: The effortless return of gastric contents into the mouth, which should be clearly distinguished from vomiting or water brash 1
- Epigastric pain: Discomfort in the upper central abdomen 1
- Dysphagia: Difficulty swallowing, which may indicate complications 1
These four symptoms—heartburn, regurgitation, epigastric pain, and dysphagia—are considered the main symptoms that should be specified when evaluating reflux disease. 1
Atypical (Extra-Esophageal) Symptoms
GERD frequently presents without typical heartburn or regurgitation, making diagnosis challenging. 2, 3 Atypical manifestations include:
Respiratory Symptoms
- Chronic cough: May occur without any heartburn 1, 2, 3
- Asthma: GERD can trigger or worsen asthmatic symptoms 2, 3, 4
- Hoarseness and laryngitis: Chronic throat symptoms from reflux 2, 3
- Chronic sore throat: Persistent throat discomfort 2
Chest Symptoms
- Non-cardiac chest pain: Approximately 30% of non-cardiac chest pain is caused by GERD, though this means 70% has other causes that must be excluded 5, 4
- The chest pain from GERD can mimic cardiac angina 1
Other Manifestations
- Dental erosions: Loss of tooth enamel from chronic acid exposure 2
- Throat symptoms: Including chronic throat clearing 1
Epidemiology of Symptoms
Heartburn is extremely common in Western populations, with 44% of US adults experiencing it at least monthly and 10-20% experiencing symptoms weekly. 1
The frequency of regurgitation is less well described but also common, and it does not necessarily occur in all patients with heartburn. 1 In patients with no or mild heartburn, moderate or severe regurgitation is present in approximately 5% in primary care and 16% in specialist settings. 1
Critical Diagnostic Considerations
Symptom indices (SAP and SI) should only be used for heartburn, acid regurgitation, or chest pain—not for throat or respiratory symptoms—when based on patient reporting of symptomatic episodes. 1
The correlation between reflux symptoms and actual esophageal acid exposure is only moderate, meaning patients with severe tissue injury may have similar symptoms to those with non-erosive disease. 1 This overlap makes it difficult to identify patients at risk for complications based on symptoms alone. 1
Approximately 60% of patients with non-erosive reflux disease who are refractory to proton pump inhibitors have a positive reflux/symptom association, primarily due to non-acid reflux. 1