We’ve all seen the commercials: They almost always feature a man, his face screwed up into a grimace of pain. His hand is placed in the middle of his chest. It’s heartburn.

More than 60 million American adults experience it at least once a month — more than 15 million adults suffer heartburn daily. It’s the most common symptom of acid reflux or its more-severe version, gastroesophageal reflux disease, or GERD, which occurs when acid or other stomach contents back up into the esophagus.

Still, heartburn is not the only symptom of GERD. There are less-common symptoms that people don’t typically associate with acid reflux.

Each is related to how far up the esophagus the stomach contents, acid or bile travel, says Dr. Brian Smith, a UCI Health gastrointestinal surgeon with the H.H. Chao Comprehensive Digestive Disease Center.

Lesser-known symptoms of GERD

But what you see on TV isn’t the only way you can experience GERD. There are other, lesser-known symptoms.

• Difficulty swallowing. Difficulty swallowing may be a symptom of acid rising up into the esophagus.
• Throat and voice issues. A persistent cough, throat clearing or hoarse voice may result from GERD.
• Salivation and digestive discomfort. Excessive salivation, gas and bloating also can be symptoms.
• Regurgitation. Regurgitation of food or acid is a symptom of GERD, that is experienced by about 70 percent of patients.
• Sour taste. A sour, brash taste in the mouth or back of the mouth can also be a sign of GERD. This shows up for about 40 percent of patients with GERD.
• Asthma. Even asthma can signal laryngopharyngeal reflux, which is reported by about 15 percent to 20 percent of patients with GERD. It occurs when gastric contents flow to the upper digestive tract. Some studies suggest that as much as 80 percent of asthma may be caused by acid reflux.
• Sinus trouble. Sinus irritation or ear and nose discomfort resulting from acid reflux into the back of the throat is a still more rare indication of the condition. Some 5 percent to 10 percent of GERD sufferers describe these symptoms. “We mostly see acid reflux, but not all reflux is acid,” Smith says. “Sometimes bile is refluxed. It’s extremely irritating to the esophagus. Although less common, its symptoms are more severe.”

How heartburn feels

“We’ve all heard of heartburn,” says Smith, “but those who haven’t experienced it don’t know what it means.”

Heartburn — also called acid indigestion — is abdominal pain or a burning sensation that radiates up into the chest along the course of the esophagus that can last for a few minutes to several hours.

GERD affects 10 percent to 20 percent of Americans and is more common among people aged 50 to 70. It’s rarely life-threatening, is very treatable, but it can wreak havoc on a person’s quality of life.

How to cope with acid reflux

Smith says that patients typically know how to deal with acid reflux by:

• Sleeping elevated
• Washing food down with water or milk
• Avoiding foods like chocolate, peppermint, tomato sauce, orange juice, fried or fatty foods, coffee or alcoholic beverages (red wine in particular)

There are plenty of effective over-the-counter and prescription medications that can alleviate heartburn, Smith says.

When to see your doctor

However, people need to seek specialized care when their discomfort and symptoms rise to the alarm level:

• Chronic GERD (more than five years)
• Weight loss
• Early fullness when eating
• Persistent pain or difficult or painful swallowing

These are signs that a person should talk with a primary care provider about a referral to a gastroenterologist for an endoscopy to examine the upper digestive system.

People who have symptoms of laryngopharyngeal reflux (hoarse voice, chronic cough, throat clearing, and persistent sinus irritation) should consider requesting a referral to an ear, nose and throat specialist who can examine these areas via a nasal endoscopy.

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“Cough? Hoarse Voice? It Could Be GERD.” UCI Healthc, 26 Oct. 2017, www.ucihealth.org/blog/2017/10/gerd-symptoms.

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