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Chronic coughing in a patient with acid reflux can be a big and annoying problem. Coughing following acid reflux is mainly due to irritation. The reflux can tract high up the esophagus to the larynx and pharynx.

Irritation in this area can cause hoarseness and coughing. The reflux can also go as far as the trachea and into the bronchi. This will trigger the cough reflex. This is a natural phenomenon. If you accidentally swallow something down the wrong tube, the first thing you will do is cough.

This is a violent expulsion of air from the bronchi and will hopefully expel the offending item.

In acid reflux patients, food can regurgitate up into these areas because the lower esophageal sphincter is not functioning well and opens when it should not. Often this happens at night and sufferers wake up with a cough which may improve during the day. Acid reflux treatment is usually effective but there are some cases where acid reflux treatment is ineffective in relieving chronic coughing.

A study by Ziora et al in 2005 assessed the benefits of anti-reflux surgery on chronic cough of GERD. They used the citric acid cough threshold to assess  any change before and after surgery.

They included 30 patients with chronic cough due to GERD and 15 volunteers. The cough threshold was found in individuals by increasing the amount of citric acid consumed before cough started. 20 of these patients had surgery. This surgery was laparoscopic Toupet fundoplication.

Following surgery the cough score improved after two weeks and at 13 weeks in some the cough disappeared or was significantly improved. 14 of the 20 patients significantly improved. 3 had partial improvement and 3 had no improvement.

The trial showed that acid reflux patients have a significantly lower cough threshold than healthy subjects and that anti-reflux surgery was beneficial in GERD induced coughing.

If you have a chronic cough and you have symptoms of GERD, then you should see you doctor. Adequate acid reflux treatment will reduce acid in the refluxed gastric content and reduce the chance of inflammation in the pharynx, larynx, trachea and bronchi. Persistent high acid in this area can result in stricture just as in the esophagus. Crico-pharyngeal stricture is very unpleasant. Avoid this at all cost. Acid reflux treatment does reduce coughing due to GERD.

Dr. Phil Hariram.