This week Dr. Howard Freilich, a gastroenterologist with Coastal Carolina Hospital, discusses the connection between coughing and acid reflux.
Question: So I recently heard there may be a connection with a chronic cough and acid reflux. Is that possible and why does coughing in some instances cause acid reflux (or is it a symptom) and what can be done about it?
Answer: A chronic cough can be a difficult and frustrating problem. In many cases identifying the cause can be a challenge. There are many causes of a chronic cough. Gastroesophageal reflux has been implicated as one of many potential causes. A cough may be a symptom of gastroesophageal reflux or an occasional cause of reflux itself.
Gastroesophageal reflux disease or “GERD,” is the process of potentially irritating acidic stomach contents refluxing upward from the stomach to the esophagus. It is a common problem and can affect up to as much as one in five or more Americans at some point.
Most patients with gastroesophageal reflux will present with common typical symptoms which may include “heartburn” or a burning discomfort in the chest. However, there are patients that may present without heartburn and may have what we call atypical or “extra esophageal” symptoms. These can range from sore throat or dental decay, to pulmonary symptoms such as a chronic cough or even wheezing.
The thEory of how reflux causes these symptoms is felt to be related to a direct effect of harsh reflux contents from the stomach emerging upward as far as the pharynx or throat leading to direct irritation of structures of the throat, voice box and even sometimes the bronchial airways.
An alternate theory exists that may be related to a nerve reflex that occurs due to the reflux event, leading to spasm of the airways. These events can result in a chronic cough which can be very difficult to treat. It is possible that coughing vigorously for whatever reason could induce acid reflux in an individual prone to GERD. The mechanism may simply reflect contraction of the abdominal muscles associated with coughing that could increase pressure on the stomach and induce reflux events.
Patients often will initially be seen by their primary care doctor or an ear, nose and throat specialist for this problem. If the cough persists and the cause is not apparent, they may request a consultation with a gastroenterologist. Your digestive disease specialist has tests available to assist in making the diagnosis of cough related to gastroesophageal reflux.
Patients with this disorder will be placed on a program of high dose stomach acid suppression therapy to treat the reflux and thereby alleviate the cough.
This may take three or more months to result in improvement. A trial of therapy can act not only as targeted treatment, but if improvement occurs this can serve as a diagnostic tool to confirm a causal relationship of GERD inducing the cough.