Is Your Chronic Cough Actually GERD Cough?

GERD can sneak up on you in the form of a cough.

Gastroesophageal reflux disease (or GERD) is a digestive disorder where stomach acid and food back up into the esophagus, the tube connecting the mouth to the stomach.

Most of us occasionally experience mild acid reflux, but GERD is a more severe and persistent form of reflux. Left untreated, it leads to regular heartburn and other complications, including a reflexive “GERD cough.”

Research suggests that GERD is common, affecting around 20% of adults in the U.S., including North Carolina. The incidence of GERD varies, with some studies showing it increasing in younger age groups.

When Reflux Is “Silent”

Reflux is often silent or subtle. You may not have symptoms beyond an annoying cough, so you may not be aware of the underlying issue.

When a patient comes to us with a persistent cough, we routinely test for infection, asthma, allergies, or sinus issues. If coughing seems severe, we may order a chest X-ray or do spirometry (pulmonary function testing) right in the office to rule out asthma.

If coughing and other symptoms go away after a couple of weeks, they’re likely not caused by reflux. But a cough that persists for four to six weeks may well be a GERD cough — that is, reflux-induced:

• In the case of laryngopharyngeal reflux (LPR), acid seeps high through the esophagus’s upper sphincter — into the back of the throat and sinuses. This may cause chronic hoarseness, sinus infection, sore throat, or a cough with the need to constantly clear your throat.
• When reflux is subtle and there’s just a cough, the issue can originate from the lower esophageal sphincter.

Even as we await other test results, we often take precautions to treat the esophagus for possible GERD.

Treating Reflux

If your tests show no signs of asthma or infection (e.g., dark-colored sputum, fever, shortness of breath, wheezing), we look for other hints (typical of esophageal reflux) that may indicate a GERD cough:

• “My cough seems to intensify after I eat.”
• “My cough worsens when I lie down but improves when I sit up.”
• “I’ve eaten a lot of tomatoes (or other acidic foods) lately.”
• “If I eat late at night, I cough more.”

As mentioned, we may begin preemptive treatment of your GERD cough, as the risk is low to start treating, and it can take a few weeks to correct the reflux.

Also, one of our gastrointestinal (GI) professionals will check your esophagus and perhaps order an upper endoscopy to assure reflux hasn’t caused structural issues or chronic damage.

For LPR of the upper esophageal sphincter, we may refer you to an ear, nose, and throat specialist (ENT) to perform a laryngoscopy through the nose and look for signs of acid damage in the larynx and back of the throat.

When reflux-induced cough persists for quite a while, coughing symptoms can worsen. We suppress your gastritis and gradually diminish coughing by placing you on a proton pump inhibitor (PPI) for about six weeks. PPI is a very safe, low-cost treatment, often available over the counter.

Careful dietary protocols are also a primary defense in healing reflux damage. We advise you to:

• Adopt a low-acidity diet. That includes cutting back on tomatoes, cooked onions, spicy foods, citric acids, carbonated beverages, coffee, tea, chocolate, sodas, and alcohol.
• Don’t eat late at night (particularly large meals) just before bedtime.

When to See a Doctor for GERD Cough

If you’ve had allergies or a cold, it’s natural to have a cough that lingers for several days afterward.

But when you experience a seemingly random cough that lingers for a month or more and isn’t improving, it’s time to bring it to your Signature Healthcare physician. We’ll check for possible causes and begin proactive treatment if it may be a GERD cough.

Give us a call. The sooner we see you, the faster we can rid you of your cough, undo any damage, and get you feeling your best again.