Decades of severe heartburn and other symptoms of gastroesophageal reflux disease (GERD)—a very common condition in which stomach acid is flushed backward into the esophagus—had worn Clara down. By the time she was in her 80s, she had long since given up trying to deal with the problem. She ate foods she knew would trigger symptoms, didn’t take medications as directed, and skipped lifestyle changes her doctor recommended.

When Clara started having trouble swallowing, she chalked it up as another GERD symptom and ignored it, too. But this time it meant something far worse: esophageal cancer, the sixth leading cause of cancer death worldwide.

Most cases of GERD do not lead to esophageal cancer, says a Harvard expert. But recurrent or persistent acid reflux should be evaluated and treated—not only because untreated GERD can damage the esophagus, but because symptoms you think are “just GERD” can signal other health problems, some of which can be life-threatening.

“It’s important to know what you’re dealing with—whether it’s GERD or something else,” says Dr. Elena Fradkov, a gastroenterologist at Harvard-affiliated Mount Auburn Hospital. “And if it’s something as scary as a heart attack, you don’t want to miss it.”

Similar conditions

Heartburn is perhaps the most common GERD symptom. “But you may also have a sour or metallic taste in your mouth, a hoarse voice, chest pain, dry cough or post-nasal drip,” says Dr. Fradkov.

These symptoms may overlap with those of several other conditions, including the following:

Hiatal hernia. A condition in which part of the stomach protrudes through the diaphragm (a sheet of muscle that separates the chest cavity from the stomach), a hiatal hernia can trigger GERD or simply coexist with it, often without even causing symptoms, notes Dr. Fradkov. “Normally, the diaphragm sits where the esophagus and stomach meet,” she explains. “When there is a hiatal hernia, the top of the stomach almost looks like a tube of toothpaste being squeezed in the middle.” This can cause symptoms associated with GERD.

Functional dyspepsia. This is a complicated name for stomach discomfort, pain or chronic indigestion that does not stem from an identifiable cause. “There is no acid reflux in the esophagus,” says Dr. Fradkov. “But people who have it can have symptoms of GERD anyway.”

Eosinophilic esophagitis. Eosinophils are a type of white blood cell involved in allergic reactions. When they accumulate in the esophagus, this allergic condition inflames the muscular tube, causing difficulty swallowing and other GERD-like symptoms. “The main difference is that eosinophilic esophagitis typically involves much more classic difficulty swallowing or food sticking,” she says, “whereas typical GERD symptoms include burning, a metallic taste in the mouth, hoarseness, or bad breath.”

Esophageal spasms. Certain medications, as well as eating very cold or very hot foods, can cause involuntary contractions of the esophagus. Like GERD, these spasms can cause pain, difficulty swallowing, and the feeling that food is stuck in your chest.

Heart attack. Heart attacks sometimes involve a burning sensation along with more typical chest pain. “You might think it’s just your GERD, but if you’re also sweaty, have trouble breathing, or feel pain radiating into your back, you need to go to the hospital,” says Dr. Fradkov.

Proactive strategies

Depending on your age and other health problems, diagnosing GERD may involve various tests, including an endoscopy, in which a doctor looks directly at the lining of the esophagus using a camera on a tube passed down the throat. “We can sometimes see inflammation in the esophagus,” says Dr. Fradkov. “It will confirm a GERD diagnosis or allow us to rule out other causes.”

If your symptoms are actually caused by GERD, your doctor may recommend over-the-counter or prescription medications. But the following lifestyle changes can usually help you manage most or all of the symptoms, says Dr. Fradkov.

Avoid common triggers. Alcohol, coffee, chocolate, tomato sauce, carbonated drinks, peppermint, citrus fruits and juices, and fried, fatty or acidic foods are all offenders.

Stretch out your eating. Instead of three large meals each day, divide your intake into five or six smaller ones and eat more slowly.

Stand upright after meals. This helps gravity move food and drinks downwards instead of allowing stomach contents to back up into the esophagus. Do not eat in the two to three hours before bed, and try to raise your upper body in bed with a foam wedge under your mattress.

Control your weight. Carrying extra pounds, especially in the stomach, puts more pressure on the sphincter muscle at the bottom of the esophagus that keeps food in the stomach. “It’s pure mechanics,” says Dr. Fradkov. “The more abdominal mass you have, the more it’s going to push on your stomach and push things up.”

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