How do I know if I have this — and which symptoms mean something else entirely?
The classic symptoms are unmistakable: burning behind the breastbone after meals, sour fluid rising into the throat. The diagnostic challenge lives at the edges — chest pain that feels exactly like a heart attack (and sometimes is one), cough and asthma that are reflux wearing a respiratory disguise, and a short list of alarm symptoms that change the management from antacids to endoscopy. This chapter teaches the pattern and the boundaries.
Burning pressure behind the breastbone, typically 30–60 minutes after meals, worse lying down or bending — acid's signature against an unarmored lining.
CommonSour or bitter fluid rising into the throat or mouth — the symptom that most purely reflects the barrier failing, and the one that best predicts surgical response.
CommonWaking with sour taste, coughing, or choking — hours-long acid dwell time, the dangerous pattern that drives complications and airway symptoms.
CommonChronic cough, morning hoarseness, throat clearing, and asthma flares — reflux presenting as an airway disease, often with zero heartburn.
CommonThe single most important sentence on this page: reflux and cardiac chest pain can be indistinguishable — both produce burning pressure behind the breastbone, both can radiate, both can sweat you and sicken you. The rule that saves lives: new chest pain gets treated as cardiac until a physician says otherwise — especially with exertion, shortness of breath, radiation to arm or jaw, or any cardiac risk profile. Acid has never once been diagnosed by assuming the safer cause first.
The airway connection runs in both directions. Refluxate micro-aspirating at night or triggering vagal reflexes provokes cough, laryngitis, and bronchospasm — and asthma medications (theophylline, some inhalers) can relax the LES, worsening reflux. Gastroenterologists and pulmonologists have learned to check each other's organ: difficult-to-control asthma deserves a reflux evaluation (the rebuilt asthma page lists GERD among its comorbidities for exactly this reason), and stubborn reflux deserves a breathing and sleep review. Where both live together, the night is the shared battlefield.
Select a trigger
Reflux risk factors cluster into four families. Knowing yours shapes the plan:
Call 911 or seek emergency care immediately if you experience: