Surprising symptoms of chronic heartburn

With a name like heartburn, it's easy to assume that the condition always shows up as a fiery feeling in your chest or stomach. While that's certainly the classic symptom, chronic heartburn can also make its presence known in other ways, such as a tingling feeling in the nose, chest pressure, a bitter or metallic taste, a hoarse voice, tooth damage, or a dry cough.

What's the link between these symptoms and that spicy spaghetti you had for dinner? Stomach acid. It can leak up into the esophagus, the tube that carries food from the mouth to the stomach. Chronic leakage is a condition called gastroesophageal reflux disease (GERD) and is responsible for symptoms that you might mistake for other conditions.

Heart symptoms

Sometimes acid reflux irritates the upper part of the stomach or the esophagus, which can cause chest pain or pressure, mimicking pain from a partial blockage in a heart artery or even a heart attack.

What you should do. If you're worried about sudden pain in your chest, don't try to figure out if it's heartburn. "This is especially true for people with heart disease risk factors," says Dr. Christopher Cannon, a cardiologist and editor in chief of the Harvard Heart Letter.

But discerning the difference between heartburn and heart problems is complicated, and it's best to talk to a doctor about it.

"Chest pain can come from many causes, like acid reflux, but also stress, lung irritation, or muscle aches," Dr. Cannon says. "We have to consider your heart disease risk factors. For example, do you have high blood pressure or diabetes? Does the pain come with exercise? Those could all point to heart trouble, and we might order tests. If the pain comes when you lie down after eating a heavy meal, and taking an antacid makes it better, then it's likely heartburn."

Nose or throat symptoms

In GERD, stomach acid can get up high in the throat and even the area behind the nose, triggering a number of potential symptoms.

"The upper airway isn't built to have the same protections as the stomach or esophagus, so when reflux comes up, it causes injury, almost like a low-level chemical burn. It can cause a dry cough, a sore throat, a hoarse voice, a feeling like there's a lump or mucus plug in the back of the throat, or a tingling feeling in the nose," says Dr. Neil Bhattacharyya, an ear, nose, and throat specialist (ENT) at Harvard-affiliated Massachusetts Eye and Ear.

Because these symptoms overlap with many other conditions, such as a cold or allergies, it can be a long time before you recognize that you have GERD.

What you should do: If you suspect GERD might be causing your symptoms, talk to your primary care provider or an ENT. "We usually recommend that someone go on a four-week trial of heartburn medications, such as over-the-counter omeprazole, and make temporary lifestyle changes to avoid heartburn triggers," Dr. Bhattacharyya says. (See "Lifestyle strategies to combat heartburn.")

"If symptoms improve after four weeks, it's a good indicator that you probably have reflux disease," Dr. Bhattacharyya says.

Mouth or dental symptoms

For some people, GERD symptoms might seem more like mouth or dental problems.

"If the acid reaches your mouth, you might develop mouth sores or ulcers, erosion or wear on your teeth, or cavities. The cavities could be due to the acid, sugary heartburn medications, your diet, poor oral hygiene, or a combination of those factors," says Dr. Tien Jiang, a prosthodontist in the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine. Acid reflux can also create a bitter or metallic taste in the mouth.

What you should do. If you suspect that acid reflux is reaching your mouth, rinse frequently with water to neutralize it and protect your gums, soft tissues, and teeth. "Wait 30 minutes after meals or after detecting reflux to brush your teeth. This allows your saliva — and water that you rinse with or drink — to neutralize the mouth's acidity," Dr. Jiang says. "Just before brushing, rinse with water to eliminate the acid first, so you don't accidentally brush the acid against your teeth and cause more extensive wear. And get your teeth cleaned at least twice a year."

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