The most common acid reflux symptoms are heartburn and regurgitation. Heartburn is a burning sensation in the middle of your chest, behind your breastbone, that rises upward toward your throat. Regurgitation is the backflow of stomach contents into your throat or mouth, often leaving a sour or bitter taste. But reflux can show up in less obvious ways too, from a persistent cough to a hoarse voice to worn-down tooth enamel.
Heartburn and Regurgitation
Heartburn tends to follow a predictable pattern. It usually kicks in after eating, while lying down, or when bending over. It can wake you from sleep, especially if you ate within two hours of going to bed. Antacids typically bring relief, which is one way people learn to recognize the sensation as reflux rather than something more serious.
Regurgitation often accompanies heartburn but can also occur on its own. You might notice a small amount of food or liquid rising into the back of your throat, sometimes with an acidic taste that’s strongest when you’re lying flat. Some people describe it as a warm, wet burp. Both symptoms can range from mildly annoying to severe enough to interfere with eating, sleeping, and daily comfort.
Throat and Voice Symptoms
Not everyone with reflux feels the classic chest burn. When stomach acid travels high enough to reach the throat and voice box, it causes a condition sometimes called “silent reflux” or laryngopharyngeal reflux (LPR). The hallmark symptoms are hoarseness or a noticeable drop in your voice register, a persistent feeling of something stuck in your throat (sometimes called a globus sensation), and constant throat clearing. Many people with LPR never experience traditional heartburn, which is why it often goes unrecognized for months or years.
Chronic Cough and Breathing Problems
Reflux can trigger respiratory symptoms through two routes. Acid that reaches the airway directly irritates and inflames the tissue lining your throat, voice box, and even your windpipe. But acid doesn’t always have to travel that far. Acid in the lower esophagus can stimulate nerve pathways that trigger coughing, wheezing, or tightening of the airways, a reflex reaction that happens even when acid stays well below the throat.
The result can look a lot like asthma or allergies: a dry, nagging cough that won’t quit, wheezing, or a tight feeling in the chest. Nighttime coughing fits are especially common because lying flat makes it easier for acid to creep upward. Researchers have also linked nighttime reflux to throat spasms and worsening of obstructive sleep apnea, though it’s not fully clear whether reflux causes sleep apnea or they simply share the same risk factors (like excess weight).
Nighttime Symptoms and Sleep
Reflux at night is more than just inconvenient. Your body’s natural defenses against acid exposure weaken during sleep. You swallow less often, produce less saliva, and spend hours in a horizontal position that gravity can’t help with. The result is that nighttime reflux episodes tend to last longer and expose your esophagus to acid more intensely than daytime episodes.
Common nighttime signs include waking up with a sour taste, coughing, or a choking sensation. Some people bolt awake gasping, which can feel alarming. Poor sleep quality is one of the most reported consequences of nocturnal reflux, and it creates a cycle: disrupted sleep increases sensitivity to pain and discomfort, making reflux symptoms feel worse the next day.
Dental Erosion
One of the less recognized signs of chronic reflux is damage to your teeth. Stomach acid has a pH around 1 to 2, which is far more acidic than the threshold (about pH 5.5) at which tooth enamel starts to dissolve. Unlike cavities, this erosion happens without bacteria. It’s a direct chemical wearing away of hard tooth structure.
The pattern is distinctive. Erosion typically appears first on the inner (palatal) surfaces of the upper front teeth, the surfaces closest to where regurgitated acid lands. Your dentist may spot this before you notice any reflux symptoms yourself, making dental erosion an early clue to silent reflux. Over time, teeth can become thin, translucent at the edges, or increasingly sensitive to temperature.
Symptoms in Infants
Babies can’t describe heartburn, so reflux shows up as behavioral changes. Spitting up is normal in infants, but when it’s accompanied by other signs, it may point to something more than ordinary reflux. Watch for arching of the back during or after feeding, abnormal movements of the neck and chin, and irritability that gets worse with regurgitation. Some infants lose interest in feeding or refuse to eat altogether. In more significant cases, poor weight gain, a persistent cough, or wheezing can develop.
How Heartburn Differs From a Heart Attack
Chest pain from reflux and chest pain from a heart attack can feel strikingly similar. Even experienced doctors sometimes can’t tell them apart based on symptoms alone, which is why emergency rooms run cardiac tests first when someone comes in with chest pain.
There are some general patterns that help distinguish them. Heartburn tends to be a burning sensation centered behind the breastbone that worsens after meals or when lying down, often accompanied by a sour taste or mild regurgitation. It typically responds to antacids. A heart attack, by contrast, more commonly feels like pressure, tightness, or squeezing in the chest or arms that may spread to the neck, jaw, or back. It can come with shortness of breath, cold sweats, sudden dizziness, or unusual fatigue. But these patterns overlap, and heart attacks can mimic indigestion. Chest pain that’s new, severe, or accompanied by lightheadedness, sweating, or pain radiating to the arm or jaw warrants emergency evaluation.
Warning Signs That Need Prompt Attention
Most reflux is manageable, but certain symptoms signal that something more serious may be happening. These red flags include difficulty swallowing (food feeling stuck or slow to go down), pain when swallowing, unexplained weight loss, vomiting blood, and black or bloody stools. These can indicate complications like narrowing of the esophagus, ulceration, or other conditions that look like reflux but aren’t. Current guidelines from gastroenterology societies recommend that people with any of these symptoms undergo an upper endoscopy to get a direct look at the esophagus and stomach lining.