Warning Signs of Reflux You Shouldn’t Ignore

Like the man in the image, you may be blindly walking into the abyss. The warning signs of reflux are not always obvious, but certain symptoms should never be ignored, as they can indicate serious underlying conditions.

It’s important to pay attention to issues with voice, breathing, and swallowing, as these may be warning signs of reflux that require medical intervention.

Progressive Symptoms: When Acid Reflux Becomes Serious

Many people experience occasional or intermittent reflux, but symptoms that progressively worsen rather than come and go should not be dismissed. If your reflux symptoms increase in severity over time, it could indicate that the underlying condition is more serious.

Below are some of the warning signs of reflux that you should not ignore:

1. Difficulty Swallowing (Dysphagia)

Trouble swallowing is a common symptom of reflux, particularly when pills or food feel stuck in the esophagus. If the sensation occurs high in the throat, it may be due to dysfunction in the upper esophageal sphincter (UES). While frustrating, this type of dysphagia is often not immediately dangerous.

However, persistent painful swallowing (odynophagia) is a more concerning sign. This may be a signal to see an otolaryngologist—ear, nose, and throat (ENT) specialist—as soon as possible. Tumors in the lower throat, particularly in an area called the pyriform sinus, can cause this symptom, and esophageal cancer can also present with progressively worsening swallowing difficulties.

Benign causes of progressive dysphagia include esophageal rings or thickened bands caused by chronic acid irritation and scarring. While not cancerous, they still require treatment.

2. Hoarseness That Progresses

Intermittent hoarseness (dysphonia) is a common sign of reflux, affecting about one-third to one-half of people with the condition. It is usually worse in the morning and can be exacerbated by alcohol consumption, leading to the so-called “whiskey voice.”

However, progressive voice loss is concerning. One potential cause is vocal cord paralysis, which occurs when the vagus nerve—which controls the vocal cords—is encroached on or compressed by a tumor. The recurrent laryngeal nerve, a branch of the vagus nerve, loops into the chest before returning to the throat. This means that lung cancer (particularly in the apex of the lung) and thyroid cancer are common pernicious causes of vocal cord paralysis. If your voice loss worsens over time, seek evaluation by an ENT specialist.

Additionally, reflux that affects the airway can contribute to hoarseness, chronic throat clearing, or a sensation of throat tightness. This occurs when stomach acid or digestive enzymes reach the upper airway, causing irritation and inflammation. Persistent throat discomfort or changes in voice should be evaluated.

3. Chronic Cough

A persistent chronic cough should be investigated. While often not life-threatening, it may indicate an underlying condition that requires attention. A cough that lasts over four weeks warrants chest x-rays and a tuberculosis test. If these tests are clear, it is likely that reflux is the primary cause.

Chronic throat irritation from reflux can lead to persistent coughing, as acid exposure triggers the body’s protective mechanisms to clear the airway. If you frequently feel the need to clear your throat or have a lingering cough, reflux may be the culprit.

Another possible cause is neurogenic cough, which occurs when the vagus nerve is irritated or damaged. Since the vagus nerve plays a role in regulating the airway and esophagus, dysfunction can lead to a persistent cough. Neurogenic cough can be treated, provided other causes are ruled out.

4. Heartburn Pain That Radiates to the Back

Heartburn is typically experienced as chest pain after eating, particularly after large, greasy meals or overeating. However, if your chest pain radiates to your back, it requires further evaluation.

While this type of pain can sometimes be caused by reflux, “atypical heartburn,” it is also a possible symptom of pancreatic cancer. If you have heartburn and pain that moves through to your back, schedule an appointment with a gastroenterologist for an upper endoscopy.

5. Progressive Gum and Dental Disease

Although gum recession and dental issues are common as people age, relatively rapid progression over a few months should raise concern. Reflux can severely impact oral health, particularly when acid exposure occurs overnight.

Many people with severe reflux report waking up with a bitter taste in their mouths. Dentists and oral surgeons should be aware that rapid dental deterioration in adults may indicate underlying respiratory reflux.

Other Warning Signs of Reflux That Demand Attention

• Waking Up Coughing: If you wake up in the middle of the night coughing, your reflux is likely severe and should be evaluated.
• Choking Episodes: Frequent choking can be a sign of reflux-related aspiration and should be addressed.
• Sleep Apnea: In my experience, 90% of people with sleep apnea have had long-standing respiratory reflux. Sleep apnea is a serious condition with major cardiovascular and pulmonary consequences. If you snore or have sleep apnea, lifestyle changes may help.

Recommendations for Managing Reflux

• Weight Management: If you are overweight, consider a weight-loss program. Additional weight in the abdominal area increases pressure on the stomach and greatly increases the chances of stomach contents refluxing into the esophagus.
• Adjust Sleeping Position: Sleeping on an elevated bed or in a recliner helps prevent reflux from worsening overnight, as gravity keeps acid from moving upward.
• Avoid Trigger Foods: Avoid the foods most likely to contribute to reflux, including reducing or eliminating carbonated beverages and alcohol.
• Consider a Reflux Detox Program: This program targets the most common dietary and other causes of reflux to alleviate symptoms and stop progression.

Conclusion

If you experience any of these warning signs of reflux, don’t ignore them. Early intervention can prevent serious complications and improve your quality of life. Consult a specialist if you notice progressive swallowing issues, voice changes, persistent cough, or any other concerning symptoms. commitment to the necessary changes.

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For more information about diagnosis and treatment of acid reflux, see two companion books on Amazon: Dr. Koufman’s Acid Reflux Diet and Dropping Acid: The Reflux Diet Cookbook & Cure. If you would like to receive personalized guidance and strategies for lasting relief, consider scheduling an online consultation.