Advanced or long-standing uncontrolled GERD may present with more persistent symptoms and complication-focused signals. These can include severe or frequent heartburn, nighttime symptoms that disrupt sleep, difficulty swallowing (dysphagia), painful swallowing, a persistent “stuck” sensation in the throat, chronic cough, hoarseness, and recurrent throat irritation. Over time, strictures can develop, leading to food sticking—especially with solid foods. Alarm features include iron-deficiency anemia, unexplained weight loss, and signs of bleeding (black stools, vomiting blood). At this stage, relying on home remedies can delay proper care; medical evaluation and, when indicated, endoscopy help confirm diagnosis, reduce risk, and accelerate the right treatment plan.