Chronic Cough: Is Gastroesophageal Reflux the Hidden Cause?

Q: Chronic Cough: Is Gastroesophageal Reflux the Hidden Cause?

Hello： If chronic cough is caused by gastroesophageal reflux disease (GERD), an upper endoscopy or medication treatment can be performed to achieve improvement and confirm the diagnosis. <br>If effective medications have been used without noticeable results, it may not necessaril

Chronic cough lasting for a long time that is not resolved by an otolaryngologist may be due to gastroesophageal reflux disease (GERD)?

Hello: I have had a long-term chronic cough for as long as I can remember.
I have seen many ENT specialists, and they all said it was due to post-nasal drip, but the medications they prescribed have not resolved the issue.
Should I consider getting an endoscopy to check for gastroesophageal reflux disease (GERD)? I occasionally experience abdominal pain and a burning sensation in my chest, but I avoid high-fat foods in my diet.
However, I often eat until I'm too full.
I am currently a student with a regular schedule.
Note: I underwent a sigmoid colon perforation surgery due to intussusception when I was 5 years old, and most of my colon was removed.
I was hospitalized last November for a paralytic ileus.

A Kai, 20~29 year old female. Ask Date: 2013/01/12

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello: If chronic cough is caused by gastroesophageal reflux disease (GERD), an upper endoscopy or medication treatment can be performed to achieve improvement and confirm the diagnosis.
If effective medications have been used without noticeable results, it may not necessarily be GERD, but could instead be an issue related to the trachea or nasopharynx.
Wishing you good health, Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health.

Reply Date: 2013/01/12

More Info

Chronic cough can indeed be a perplexing issue, especially when traditional treatments fail to provide relief. Based on your description, it seems that you have been experiencing chronic cough for a long time, and despite consultations with various ENT specialists who attribute your symptoms to post-nasal drip, you have not found satisfactory resolution. This raises the question of whether gastroesophageal reflux disease (GERD) could be a contributing factor to your chronic cough.

GERD occurs when stomach acid frequently flows back into the esophagus, leading to irritation and inflammation. This condition can manifest in various ways, including heartburn, regurgitation, and, notably, chronic cough. In fact, studies have shown that a significant number of patients with chronic cough have underlying GERD, even if they do not experience typical symptoms like heartburn. The cough can be triggered by the acid irritating the throat or by aspiration of refluxed material into the lungs.

Given your history of abdominal issues, including surgery for intussusception and a significant portion of your colon being removed, it is possible that your gastrointestinal system may be more sensitive. Additionally, your mention of occasional abdominal pain and a sensation of heat in your chest could suggest that your digestive system is reacting to certain foods or eating patterns. Eating large meals or high-fat foods can exacerbate GERD symptoms, leading to increased reflux and, consequently, cough.

Considering your symptoms and medical history, it would be prudent to explore the possibility of GERD further. An upper endoscopy (esophagogastroduodenoscopy or EGD) can be a valuable diagnostic tool in this situation. It allows for direct visualization of the esophagus, stomach, and duodenum, and can help identify any inflammation, ulcers, or other abnormalities that may be contributing to your symptoms. Additionally, it can help assess the function of the lower esophageal sphincter, which plays a crucial role in preventing reflux.

In the meantime, there are several lifestyle modifications you can implement to help manage your symptoms. These include:
1. Dietary Changes: Avoid foods that are known to trigger reflux, such as spicy foods, citrus, chocolate, caffeine, and high-fat meals. Eating smaller, more frequent meals rather than large ones can also help reduce the pressure on your stomach.

2. Posture: Try to remain upright for at least two to three hours after eating to minimize the chances of reflux. Elevating the head of your bed can also help reduce nighttime symptoms.

3. Weight Management: If applicable, maintaining a healthy weight can alleviate pressure on the abdomen and reduce the likelihood of reflux.

4. Avoiding Tight Clothing: Wearing loose-fitting clothes can help reduce pressure on your stomach.

5. Medication: Over-the-counter antacids or proton pump inhibitors (PPIs) may provide relief from symptoms. However, it is essential to consult with a healthcare provider before starting any new medication, especially given your medical history.

In conclusion, while post-nasal drip may be a contributing factor to your chronic cough, it is essential to consider GERD as a potential underlying cause. An upper endoscopy can provide valuable insights into your gastrointestinal health and help guide appropriate treatment. Meanwhile, implementing lifestyle changes can help manage your symptoms and improve your quality of life. If your cough persists despite these measures, further evaluation by a gastroenterologist may be warranted.

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