While most people experience occasional acid reflux, some people may develop a more serious form of acid indigestion. This is known as gastroesophageal reflux disease (GERD). People with GERD experience chronic, persistent reflux that occurs at least twice a week.
Many people with GERD have daily symptoms that can lead to more serious health problems over time. The most common symptom of acid reflux is heartburn, a burning sensation in the lower chest and middle abdomen. Some adults may experience GERD without heartburn as well as additional symptoms. These can include belching, wheezing, difficulty swallowing, or a chronic cough.
GERD is one of the most common causes of a persistent cough. In fact, researchers at the University of North Carolina School of Medicine estimate that GERD is solely responsible for over 25 percent of all cases of chronic cough. The majority of people with a GERD-induced cough don’t have classic symptoms of the disease like heartburn. Chronic cough can be caused either by acid reflux or sometimes by the reflux of non-acidic stomach contents.
Some clues as to whether a chronic cough is caused by GERD include:
- a nonproductive cough that occurs mostly during the day while you’re in an upright position
- a persistent cough that occurs even when common causes are absent, such as smoking or taking medications (like ACE inhibitors) in which coughing is a side effect
- coughing without asthma or postnasal drip, or when chest X-rays are normal
People without heartburn symptoms make GERD more difficult to diagnose. This is because acid reflux isn’t the most common cause of symptoms such as chronic cough. GERD also often doesn't show up in noninvasive radiologic tests such as barium swallow — the most commonly used test for GERD — in people with atypical symptoms.
Another way to find out whether a cough is GERD-related is to go on proton pump inhibitors (PPIs), a type of medication for GERD, for a period of three months to see if symptoms resolve. PPIs include medications such as Nexium, Prevacid, and Prilosec, among others. A positive response to PPI therapy is a sign that you likely have GERD.
One of the best tests for GERD in patients with chronic cough is the 24-hour pH probe, which monitors esophageal pH. Another test, known as MII-pH, can detect non-acid reflux as well. Both of these tests are more invasive, more expensive, and generally not as available as the barium swallow. If your doctor is certain you have GERD, she may not order any diagnostic tests, and rather just prescribe you a medication such as a PPI.
Most infants experience some degree of acid reflux during their first year of life. Normal symptoms include frequent spitting up or vomiting in infants who are otherwise happy and healthy. However, infants who experience acid reflux after one year of age may indeed have GERD. Frequent coughing is one of the main symptoms in children with GERD. Additional symptoms may include:
- repeated vomiting
- laryngitis (hoarse voice)
Infants and young children with GERD may:
- refuse to eat
- act colicky
- become irritable
- experience poor growth
- arch their backs during or immediately following feedings
You’re at greater risk for developing GERD if you smoke, are obese, or are pregnant. Eating certain foods also can exacerbate GERD. These foods include:
- alcoholic beverages
- caffeinated beverages
- citrus fruits
- fried and fatty foods
- mint and mint-flavored things (especially peppermint and spearmint)
- spicy foods
- tomato-based foods including pizza, salsa, and spaghetti sauce
Lifestyle changes will often be enough to reduce or even eliminate a chronic cough and other symptoms of GERD. These changes include:
- avoiding foods that make symptoms worse
- avoiding lying down for at least 2.5 hours after meals
- eating frequent, smaller meals
- losing excessive weight
- quitting smoking
- raising the head of the bed between 6 and 8 inches (extra pillows don't work)
- wearing loose-fitting clothing to relieve pressure around the abdomen
Medications — especially PPIs — are generally effective in treating symptoms of GERD. Other medications that may help include:
- antacids (such as Alka-Seltzer, Maalox, Rolaids, or Tums)
- foaming agents like Gaviscon (which reduces stomach acid by delivering an antacid with a foaming agent)
- H2 blockers, such as Zantac and Tagamet HB (which decrease acid production)
- prokinetics like Reglan (which helps the stomach empty more quickly but has frequent side effects, including anxiety, depression, and fatigue)
Surgery can be an effective treatment for those who don’t respond well to either lifestyle changes or medications.
Talk to your doctor about your risk for GERD if you or someone you know suffers from a persistent cough. If you’re diagnosed with GERD, be sure to follow your medication regime and keep your scheduled doctor’s appointments.