GERD: Why Coughing and Throat Pain Persist Despite Treatment

Gastroesophageal reflux disease (GERD) with sore throat and cough?

Hello, doctor.
I have been coughing due to gastroesophageal reflux for two months.
Initially, my symptoms worsened after taking Western medicine, so I switched to traditional Chinese medicine.
Now, I only occasionally have phlegm and clear my throat.
The Chinese medicine practitioner mentioned that my stomach is still inflamed, and I am continuing to take medication for treatment.
Over the past two months, I have avoided spicy foods, coffee, tea, and have almost completely eliminated sweets, sour foods, and fried foods from my diet.
I would like to ask the doctor why, despite avoiding these foods and taking medication, my gastroesophageal reflux has not fully resolved and can only be alleviated.
Does it require more time for treatment, or is it that gastroesophageal reflux is inherently difficult to cure?

Lü Chá, 20~29 year old female. Ask Date: 2018/04/20

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, mild gastroesophageal reflux can be managed through dietary and lifestyle adjustments, along with short-term medication control, but it is prone to recurrence.
However, severe gastroesophageal reflux requires long-term medication management.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2018/04/20

More Info

Gastroesophageal reflux disease (GERD) is a chronic condition that occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn, coughing, and throat pain. Your experience of persistent coughing and throat discomfort despite treatment is not uncommon among individuals with GERD. Here’s a detailed explanation of why this might be happening and what you can do about it.

Understanding GERD and Its Symptoms
1. Mechanism of GERD: GERD occurs due to a weakened lower esophageal sphincter (LES), which normally prevents stomach contents from flowing back into the esophagus. Factors contributing to this condition include obesity, pregnancy, certain medications, and dietary choices.

2. Symptoms: Common symptoms of GERD include heartburn, regurgitation, chest pain, difficulty swallowing, and chronic cough. The cough can be particularly troublesome, as it may be a reflex response to acid irritation of the esophagus or throat.

3. Throat Pain and Coughing: The throat pain and cough you are experiencing can be attributed to the inflammation caused by acid exposure. This irritation can lead to a condition known as laryngopharyngeal reflux (LPR), where stomach acid reaches the throat and voice box, causing symptoms like a persistent cough, throat clearing, and discomfort.

Why Treatment May Not Fully Resolve Symptoms
1. Delayed Healing: Even with dietary modifications and medication, it can take time for the esophagus and throat to heal from the inflammation caused by acid exposure. The mucosal lining of the esophagus may need several weeks or even months to recover fully.

2. Inadequate Acid Control: If the medications you are taking (such as proton pump inhibitors or H2 blockers) are not effectively controlling acid production, symptoms may persist. It’s essential to ensure that you are on the right dosage and type of medication for your condition.

3. Lifestyle Factors: Despite your efforts to avoid trigger foods and beverages, other lifestyle factors can contribute to GERD symptoms. These include eating large meals, lying down after eating, smoking, and not maintaining a healthy weight. Even small amounts of trigger foods can exacerbate symptoms.

4. Underlying Conditions: Sometimes, other underlying conditions such as hiatal hernia, esophageal motility disorders, or even allergies can contribute to persistent symptoms. It may be beneficial to discuss these possibilities with your healthcare provider.

Recommendations for Management
1. Follow-up with Your Doctor: It’s crucial to have regular follow-ups with your healthcare provider to monitor your condition. They may suggest adjusting your medication or exploring other treatment options if your symptoms do not improve.

2. Consider Dietary Adjustments: While you have already made significant dietary changes, consider keeping a food diary to identify any additional potential triggers. Some people find relief by avoiding not just spicy and acidic foods but also high-fat meals and chocolate.

3. Elevate Your Head While Sleeping: Elevating the head of your bed can help prevent nighttime reflux. This position can reduce the likelihood of acid flowing back into the esophagus while you sleep.

4. Stay Upright After Meals: Try to remain upright for at least two to three hours after eating to help reduce the risk of reflux.

5. Explore Other Therapies: If traditional medications and lifestyle changes do not provide relief, you might want to explore other therapies, such as cognitive behavioral therapy (CBT) for managing stress, which can exacerbate GERD symptoms.

6. Consider a Referral: If your symptoms persist despite treatment, consider asking your doctor for a referral to a gastroenterologist. They can perform further evaluations, such as an endoscopy, to assess the condition of your esophagus and rule out other potential issues.

Conclusion
In summary, while GERD can be a challenging condition to manage, understanding the underlying mechanisms and being proactive about treatment and lifestyle changes can significantly improve your quality of life. It’s essential to maintain open communication with your healthcare provider to tailor a management plan that works for you. Remember, healing takes time, and with the right approach, many individuals find relief from their symptoms.

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