Chronic heartburn is the most common symptom of GERD. Acid regurgitation (refluxed material into the mouth) is another common symptom. But numerous unusual symptoms other than heartburn may be associated with GERD.
These less common symptoms may include:
- Difficulty or pain when swallowing
- Waterbrash (sudden excess of saliva)
- Dysphagia (the sensation of food sticking in the esophagus)
- Chronic sore throat
- Inflammation of the gums
- Chronic irritation in the throat
- Hoarseness in the morning
- A sour taste
- Bad breath
The good news is that these symptoms often are very responsive to medical therapy and minor changes in lifestyle, and they rarely become lifelong problems.
Some Unusual Symptoms (less common) of GERD
Sore Throat, Cough
Nocturnal reflux, especially after late-night food or alcohol intake, may reach the throat without waking you up. The refluxed gastric contents irritate sensitive tissues causing a sore throat, a need to “clear the throat,” and cough.
If due to reflux, a sore throat and cough is usually easily prevented by avoiding late night eating and drinking, and employing other anti-reflux measures.
Occasionally, gastric juice may reflux through the esophagus and upper esophageal sphincter and spill into the larynx, or voice box. The ensuing inflammation causes laryngitis and hoarseness. Damage to the larynx is sometimes visible through a scope.
Diagnosis may be difficult. Sometimes there is no heartburn to warn the individual of a reflux episode.
In some people this symptom improves using a proton pump inhibitor (PPI). More importantly, the individual should undertake the lifestyle changes necessary to minimize reflux.
Some people wake an hour or so after going to bed with attacks of choking and retching. Acid and sometimes food appear in the throat and there is severe burning.
Heartburn may or may not be present. These attacks are distressing and the burning throat may take hours to settle down.
Avoiding late night eating and drinking may again be helpful. People with sleep apnea are particularly prone to this type of attack.
There are several reports, mostly in children, which suggest that stomach acid can cause problems with tooth enamel. However, this appears to be extremely rare
There is controversy about whether GERD can contribute to chronic sinusitis, although most of the data suggests that there is no relationship. It is more likely that sinusitis and GERD are confused with each other, rather than that GERD causes the sinusitis. Both problems can be associated with sore throats, and chronic cough.
Debilitated or elderly persons may have reduced sensitivity in the throat. This may reduce the usual antireflux defenses and permit some individuals to breath in (aspirate) regurgitated material into their lungs. The result is a chemical pneumonia quickly followed by infection with opportunistic organisms.
People who are semi-conscious may be more prone to aspirate, but in healthy individuals this occurrence is rare.
There is a relationship between non-allergic (non-seasonal) asthma and GERD. Respiratory symptoms such as coughing or wheezing produce reflux by sudden, violent pressure changes in the chest and abdomen. Reflux also may occur during the deep inhalation taken before forceful exhalation by a person with asthma.
Conversely, acid reflux irritates the larynx and may cause a reflex constriction of the bronchi. In an individual, it is difficult to confirm that reflux causes asthma. The best proof is improvement of both reflux and asthma with anti-reflux therapy.
Adapted from IFFGD Publication: Unusual Symptoms and GERD by J. Patrick Waring, M.D., Digestive Healthcare of Georgia, Atlanta, GA; and IFFGD publication: What Else Can We Attribute to GERD? by W. Grant Thompson, M.D., F.R.C.P.C., Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada