Reflux symptoms

Reflux can cause a wide range of different symptoms. Many people can have reflux and no symptoms, symptoms can suddenly appear for no apparent reason. However, in most people they are long-standing and slowly progressive. Some people will have symptoms only in their stomach and oesophagus (Intestinal symptoms), some the throat (Laryngopharyngeal Reflux or silent reflux) and some the airways and lungs (Respiratory). Some will have a single symptom, for instance heartburn or a cough and others a multitude of different problems. The important questions are always could my symptoms be caused by reflux and is there another potential problem?

 

Heartburn

Heartburn is a pain in the chest or a tightening sensation or alternatively burning behind the breastbone. This is often worse during the night, after eating or bending over and the discomfort can move up to the throat or neck. It is often helped by anti-acid medications.

 

Regurgitation

Regurgitation is a sensation of acid or other stomach contents coming up the oesophagus (or gullet) into the throat or mouth. It can be associated with a sour or bitter taste. Frequently precipitated by eating and bending over, regurgitation is often worse at night, it often wakes people from their sleep in a panic with partially digested food in their mouths.

 

Dyspepsia

This is a medical term used to describe a variety of symptoms including heartburn, upper abdominal discomfort, burping, nausea, and fullness after eating. Dyspepsia is not specific to reflux.

 

Chest pain

Reflux is the most common cause of “non-cardiac chest pain”. It can be severe and even mimic a heart attack. It may be associated with eating or wake people from their sleep. It can be related with oesophageal spasm, but a cardiac cause must be ruled out before reflux recorded as the cause.

 

Swallowing difficulties

Otherwise known as dysphagia this is often a symptom associated with reflux. Acid reflux can cause inflammation in the oesophagus (oesophagitis), is associated with motility problems in the oesophageal muscle or cause scarring and narrowing. However, there are other serious causes of dysphagia including oesophageal cancer and therefore new onset dysphagia should always be assessed by a doctor.

 

Burping

Reflux is associated with burping for several reasons. It can be caused by a weak lower oesophageal sphincter and often occurs after eating as the pressure differential between the stomach and the oesophagus changes.

 

Weight loss

Occasionally patients’ reflux symptoms will be sufficiently severe that they can lose weight, usually because they tend to avoid eating but sometimes because of associated depression. Weight loss can be secondary to other serious disease and should be investigated by a doctor.

 

Globus

Described as a lump in the throat or neck and sometimes associated with a sensation of “sticking” in the throat on swallowing. It is associated with Laryngopharyngeal Reflux (LPR) and sometimes dysfunction of the upper oesophageal sphincter.

 

Ear pain

Some patients describe ear pain and think it is associated with reflux. It is possible that reflux can cause these symptoms but in clinical practice it can be very hard to obtain proof from tests.

 

Bloating

While not caused by reflux, bloating can be associated with reflux symptoms especially when belching is involved. Patients describe  “gassiness”, abdominal discomfort usually after eating and in some cases bloating can become severe enough that it perceptible swelling of the abdomen. There can be associated upper abdominal pain or discomfort.

 

Voice problems

Otherwise called “dysphonia”, LPR can cause voice weakness and huskiness.

 

Post-nasal drip

The sensation of excessive mucus accumulating in the back of the nose dripping down the back of the throat. Often caused by primary sinus problems, persistent irritation of the throat by stomach acid refluxing can cause identical symptoms.

 

Cough

Reflux is one of the most common causes of a persistent cough. Usually non-productive or seasonal, patients often find that it is worse after eating or when lying down. Sometimes anti-acid medications can help. However, it’s a common mistake to think that a failure to respond to PPIs means that reflux is NOT responsible as its thought that it is often caused by relatively weakly acidic reflux

 

Shortness of breath

Asthma is known to be more common in patients with proven reflux. However, some patients without asthma describe a feeling of shortness of breath especially on exertion or discomfort behind the breast bone with breathing.

 

Respiratory infections

Persistent aspiration (breathing in) of acid and other stomach contents into the lungs can cause infections. Sometimes patients known to have reflux will be prescribed repeated courses of anti-biotics. “Bronchiectasis”, a specific chronic lung infection is also associated with reflux.

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