A persistent cough can have many different causes, and it’s important to have this symptom evaluated by a doctor. While it’s natural to assume a chronic cough is due to a respiratory problem, you might be surprised to learn that studies indicate a persistent cough is often a sign of GERD, a condition caused when the contents of your stomach inappropriately leak into your esophagus. While most people experience occasional acid reflux, some people may develop a more serious form of acid problems. This is known as gastroesophageal reflux disease (GERD). People with GERD experience chronic, persistent reflux that occurs at least twice a week.
Certain lifestyle changes such as wearing loose clothing, eating slowly, and quitting smoking may help people with chronic cough caused by acid reflux. To diagnose GERD and an associated chronic cough, doctors will take a detailed case history and assess the individual’s symptoms. It can be more difficult to diagnose a chronic cough in those experiencing LPR without heartburn. Of course, in some cases, chronic cough may be caused or made worse by acid reflux. There are two possible mechanisms to explain this occurrence.
In one study of patients with chronic idiopathic cough and no heartburn, there was no difference in outcomes between the group that received high-dose PPIs and the group that received placebo. RM These patients fall into 2 groups.
People who have a history or smoking, chronic lung diseases such as COPD, asthma, seasonal allergies, acid reflux disease (Gastro esophageal Reflux Disease or GERD), lung cancer, and chronic infections such as tuberculosis, have chronic cough. Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue.
There are also clues that chronic cough could be related to GERD (eg, cough that occurs at night and/or postprandially, when the patient reclines, not in association with activity, and/or without the presence of postna-sal drip). RM Currently, it is very difficult to differentiate between the 2 types of cough. pH testing, pH impedance testing, and/or an upper endoscopy can be performed to look for evidence of GERD.
Less common causes of chronic cough include allergies, tumors, sarcoidosis, congestive heart failure, or other lung diseases such as chronic obstructive disease (COPD) or emphysema. Lung diseases also can cause coughing up blood.
The most common and effective surgery for long-term relief from GERD is called fundoplication. It is minimally invasive and connects the upper part of the stomach to the esophagus. This will reduce reflux.
Unfortunately, this group of patients tends not to respond well to standard GERD therapy (ie, acid suppressive therapy). Thus, when treating a patient with chronic cough, it is very important to consider both the likelihood that the patient has GERD and that the patient will respond to acid suppression. RM Two mechanisms have been proposed to explain why people with GERD develop chronic cough. The most intuitive theory is called the reflux theory, whereby reflux rises above the esophagus and upper esophageal sphincter, resulting in microaspiration as microdroplets land in the larynx or occasionally enter the bronchial tree, directly causing cough as a protective mechanism against reflux.