Gastroesophageal Reflux Disease (GERD) is a common digestive disorder where stomach contents, including acid, flow back into the esophagus. This backwash can irritate the esophageal lining, leading to various symptoms. A chronic cough lasts eight weeks or longer in adults. While many conditions can cause a persistent cough, a key question is whether GERD can be the underlying cause.
How GERD Triggers a Cough
GERD can trigger a cough through two primary mechanisms. One pathway involves direct irritation of the airways by stomach contents. When acid and digestive enzymes reflux from the stomach, they can travel up the esophagus and into the throat, potentially reaching the larynx and airways. This micro-aspiration can directly inflame and irritate these tissues, leading to a cough to clear the airways.
Another mechanism is a reflex arc involving the vagus nerve, known as the esophageal-bronchial reflex. Even if stomach acid does not directly enter the airways, its presence in the esophagus can stimulate nerve endings. These sensory nerves can trigger a cough reflex through neural pathways connecting the esophagus to the brain’s cough center. This reflex can cause coughing even without heartburn or visible aspiration.
Recognizing a GERD-Related Cough
A GERD-related cough is dry and persistent, lasting more than eight weeks. It frequently worsens at night or when lying down, as these positions can facilitate stomach contents reflux. The cough may also intensify after meals.
While some individuals only experience the cough, other common GERD symptoms often occur alongside it. These include heartburn, a burning sensation in the chest, or a sour taste from regurgitation. Additional symptoms might involve hoarseness, a sensation of a lump in the throat (globus sensation), frequent throat clearing, or difficulty swallowing. A chest X-ray appears clear in cases of GERD-related cough, and the cough may not respond to standard treatments for other common causes like allergies or respiratory infections.
Confirming and Treating the Cough
Confirming a GERD-related cough often begins with ruling out other common causes, such as postnasal drip, asthma, or medication side effects. If GERD is suspected, a healthcare professional might initiate a trial of proton pump inhibitors (PPIs), which reduce stomach acid production. An improvement in cough symptoms after 8 to 12 weeks on PPIs can suggest a GERD connection.
Further diagnostic tests include ambulatory pH monitoring, which measures acid levels in the esophagus over 24 hours to correlate reflux episodes with cough. An upper endoscopy, involving a thin camera inserted down the throat, can visualize the esophageal lining for signs of irritation or damage from acid reflux.
Treatment combines lifestyle modifications with medication.
Lifestyle Changes
Avoiding trigger foods (e.g., fatty, spicy, acidic foods, caffeine, alcohol)
Eating smaller, more frequent meals
Not lying down for at least two to three hours after eating
Elevating the head of the bed by six to nine inches
Maintaining a healthy weight
Medications like antacids, H2 blockers, and PPIs help neutralize or reduce stomach acid, alleviating symptoms.
When to Consult a Healthcare Professional
A persistent cough lasting several weeks warrants medical evaluation to determine its cause. While GERD can be a reason, other more serious conditions might also manifest with a chronic cough. Seeking professional advice is important if the cough is accompanied by “red flag” symptoms.
Red Flag Symptoms
Difficulty breathing
Wheezing
Chest pain
Coughing up blood or pink-tinged phlegm
Unexplained weight loss
Night sweats
Fever above 100.4 degrees Fahrenheit
Self-diagnosis is not a substitute for a thorough medical assessment, as a healthcare provider can conduct appropriate tests to identify the underlying cause and recommend an effective treatment plan.