Occasional or persistent cough may be a sign of acid reflux and gastroesophageal reflux disease (GERD). Managing acid reflux often improves chronic cough and provides relief, unless there are other underlying causes.

People with GERD experience chronic, persistent acid reflux that occurs at least twice a week.

The most common symptom of GERD is heartburn, a burning sensation in the chest and middle abdomen. Additional symptoms may include belching, wheezing, and difficulty swallowing. Chronic cough is also a common sign of acid reflux, even in the absence of other symptoms.

GERD is one of the most common causes of chronic cough. Chronic, in this instance, refers to a cough that lasts 8 weeks or longer.

People with reflux-related chronic cough may or may not have other symptoms, or these may not be severe. If GERD symptoms are present, these may include:

Some clues as to whether your chronic cough is related to GERD may include:

  • coughing mostly at night or shortly after a meal
  • increased coughing when you lie down
  • persistent coughing in the absence of other common causes, such as tobacco use, respiratory infections, or medications (including ACE inhibitors) in which coughing is a side effect
  • coughing without asthma or postnasal drip
  • clear chest X-rays

Read about GERD-related shortness of breath.

Why GERD causes chronic cough is not fully understood. Experts associate GERD cough with two main mechanisms:

  • a protective cough reflex from the vagus nerve, which is responsible for digestion and breathing, when stomach contents rise into the esophagus
  • a regurgitation or microaspiration (inhalation of very small amounts) of acid and other stomach contents that reach the throat

In some cases, chronic cough may co-occur with GERD but have other causes, like asthma, postnasal drip, or bronchitis.

GERD can be difficult to diagnose in people who have a chronic cough but no heartburn symptoms. The upper endoscopy, or EGD, is the most often used test to evaluate symptoms.

The 24-hour pH probe, which monitors the pH in your food pipe, is also an effective test for people with chronic cough who may not have other evident signs of acid reflux. The MII-pH test can also detect nonacid reflux. The barium swallow, once the most common test for GERD, is no longer recommended.

A doctor may also try proton pump inhibitors (PPIs), a type of medication for GERD, for a period of time to see if symptoms resolve. If your symptoms improve with PPI therapy, it is likely you have GERD.

PPI medications are some of the common over-the-counter (OTC) medications for GERD, though also available in prescription strength.

GERD in children

Infants may experience some symptoms of acid reflux, such as spitting up or vomiting, every now and then.

If they continue to experience acid reflux after age 1 year, they may receive a GERD diagnosis. Frequent coughing is one of the main symptoms in children with GERD. Additional symptoms may include:

  • heartburn
  • repeated vomiting
  • hoarse voice
  • wheezing

Infants and young children with GERD may:

  • refuse to eat
  • act colicky
  • become irritable, especially after eating
  • arch their backs during or immediately following feedings

Read more about signs of GERD in infants.

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Tobacco use, obesity, and pregnancy may facilitate or exacerbate GERD symptoms, like cough, by weakening or relaxing the lower esophageal sphincter, a group of muscles at the end of the esophagus. When the lower esophageal sphincter is weakened, it allows the contents of the stomach to come up into the food pipe and throat.

Certain foods and drinks can also make GERD worse. They include:

Lifestyle changes may reduce or resolve 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
  • managing overweight
  • 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, including coughing. Other medications that may help include:

  • antacids, such as Alka-Seltzer, Mylanta, Rolaids, or Tums
  • foaming agents, such as Gaviscon, which reduce stomach acid by delivering an antacid with a foaming agent
  • H2 blockers, such as Pepcid, which decrease acid production

If medications, lifestyle changes, and diet modifications do not relieve your symptoms, it may be a good idea to consult with a healthcare professional. Other treatments, like surgery for GERD, may be an effective option for those cases that don’t respond well to conservative strategies.

The most common and effective surgery for long-term relief from GERD is fundoplication. It is minimally invasive and wraps the upper part of the stomach around the esophagus, reducing reflux. Health insurance may cover this surgery.

Read more about treatments for GERD.

Chronic cough may be a sign of GERD, even in the absence of other common GERD symptoms, like heartburn. Testing for GERD is a good idea if cough has been present for 8 weeks or longer, and there’s no other evident cause for it.

Treating GERD may require lifestyle changes, like limiting alcohol and tobacco, and medication therapy. Relief is possible.