A persistent cough can be a symptom of gastroesophageal reflux disease (GERD). This chronic cough arises when stomach contents frequently flow back into the esophagus, leading to irritation and triggering a cough reflex. Recognizing this connection is a step toward finding relief for what can be a disruptive condition.
How GERD Causes a Cough
The link between GERD and a chronic cough involves two main mechanisms. One is direct irritation of the throat and airways by refluxed stomach acid. When stomach acid reaches the larynx and pharynx, it causes inflammation and prompts a cough as the body attempts to clear the irritant. This is often called microaspiration, where tiny droplets of stomach contents are inhaled.
Another mechanism involves a reflex arc mediated by the vagus nerve. Even without direct aspiration, acid in the lower esophagus can stimulate nerve endings, sending signals to the brain that trigger a cough reflex. Unlike coughs from respiratory infections, a GERD cough does not produce phlegm and may worsen after meals or when lying down.
Lifestyle and Dietary Changes
Managing a GERD cough often begins with daily habit and food choice adjustments. Avoiding certain foods significantly reduces reflux. Common dietary triggers include spicy foods, acidic items like citrus fruits and tomatoes, fatty or fried foods, chocolate, peppermint, caffeine, and alcohol. Limiting these helps decrease stomach acid production and prevent backflow.
Changes in eating patterns also help manage GERD symptoms. Eating smaller, more frequent meals reduces pressure on the lower esophageal sphincter, the muscle that normally prevents reflux. Avoid eating for at least two to three hours before bedtime, allowing food to digest and acid levels to decrease. Elevating the head of the bed by six to eight inches, perhaps with wedges under the mattress, uses gravity to keep stomach contents down during sleep.
Maintaining a healthy weight reduces abdominal pressure, which in turn lessens reflux. Loose-fitting clothing around the waist also helps prevent compression. Quitting smoking is beneficial, as nicotine relaxes the lower esophageal sphincter, making reflux more likely. Reducing alcohol consumption contributes to overall symptom improvement by avoiding irritation of the esophageal lining.
Medication Treatments
When lifestyle changes are insufficient, medications can manage GERD and its cough. Over-the-counter options provide initial relief by neutralizing or reducing stomach acid. Antacids, like calcium carbonate or aluminum hydroxide/magnesium hydroxide, offer quick, temporary relief by neutralizing stomach acid. These are used for infrequent or mild symptoms.
Histamine-2 receptor blockers (H2 blockers) reduce stomach acid production. Medications like famotidine or ranitidine block histamine’s action on stomach cells, decreasing acid secretion. H2 blockers provide longer-lasting relief than antacids and are often taken before meals to prevent symptoms. They are effective for moderate, less frequent reflux.
Proton Pump Inhibitors (PPIs) are stronger medications that block acid production more completely and for longer. Examples include omeprazole and esomeprazole. PPIs work by irreversibly binding to and deactivating proton pumps in stomach cells responsible for secreting acid. They are typically prescribed for severe or persistent GERD symptoms and are often taken once daily before the first meal. Consistent use as directed by a healthcare professional is important for long-term acid suppression and symptom control.
Procedural and Surgical Options
For individuals whose GERD cough does not respond to lifestyle changes or medication, advanced interventions may be considered. These procedures aim to strengthen the lower esophageal sphincter (LES) or prevent reflux by altering anatomy. One common surgical option is Nissen fundoplication, where the upper part of the stomach is wrapped around the lower esophagus and sewn into place. This creates a tighter valve, reinforcing the LES and physically preventing stomach acid from flowing back up.
Another option is the LINX Reflux Management System, which involves implanting a small, flexible ring of magnetic titanium beads around the lower esophagus. The magnetic attraction between the beads helps keep the weakened LES closed to prevent reflux, but the ring temporarily opens when swallowing food or liquids. These procedures are generally considered for patients with severe, persistent GERD symptoms that significantly impact their quality of life, and they require thorough evaluation by a specialist.