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Heartburn, a burning sensation that radiates from the stomach to just behind the sternum or even to the throat, is the primary symptom of acid reflux disease. Heartburn is typically worse after a heavy meal and during postural changes, especially while lying on the back. Occasional heartburn is common and not necessarily indicative of reflux disease, unless other acid reflux symptoms are noted.

Often, with acid reflux, the most severe and persistent complaint is heartburn. Any severe chest pain should be evaluated by a physician to determine the cause of the pain is, in fact, heartburn and not cardiac related pain, such as infarction or angina. With acid reflux disease, chest pain most often presents at night because of the postural changes as noted above.

Dyspepsia is a chronic or recurring pain in the upper abdomen. This may be a sign of acid reflux, although other acid reflux symptoms should also be present in order to make a definitive diagnosis. Dyspepsia can exist by itself as well and does not necessarily represent esophageal damage. Dyspepsia may involve nausea or just a feeling of being "stuffed".

The next most common of the acid reflux symptoms is regurgitation, a sudden feeling of the stomach contents flowing back up the esophagus into the throat or mouth. In severe cases, the contents may actually be burped or even vomited. Regurgitation may or may not be associated with nausea. Occasional regurgitation occurs, especially in children, and by itself does not indicate reflux disease.

Many other symptoms of acid reflux disease exist, however they are less common. These may include a rough unproductive cough, hoarseness, gasping for breath or laryngitis. Less common are chronic sore throat, a "lump-in-the-throat" feeling, sinusitis or chronic hiccups. A very rare symptom, not linked to any of the other symptoms, is chronic nausea, possibly lasting for months intermittently.

Usually a diagnosis of acid reflux disease can be made without difficulty by a primary care physician. However, the multitude of symptoms that manifest in acid reflux requires that all differential diagnosis should be ruled out before declaring a definitive diagnosis. When a difficult case presents itself, a trial dosage of medication to temporarily stop stomach acid secretion often produces a clear diagnosis.