Gastroesophageal reflux disease (GERD) is a common digestive complaint. You can find patients with symptoms of GERD at the gastroenterology, otolaryngology or even cardiology clinic. When stomach acid backs up (refluxes) into the oesophagus, it can irritate the throat and cause coughing. This may or may not occur with other symptoms such as hiccups, regurgitation or nausea. Researchers at the University of North Carolina School of Medicine estimate that GERD is responsible for over 25% of all cases of chronic cough.
There are a few factors that can increase the risk of GERD:
- Hiatus hernia
- Pregnancy
- Smoking
- Obesity
- Certain drugs
The following are some clues that point to chronic cough caused by GERD:
- Cough that occurs mostly at night or after a meal
- Coughing while lying down
- Cough in the absence of asthma or postnasal drip
- Cough without common associated symptoms like fever or phlegm and when chest X-rays are normal
- Cough that occurs in the absence of common causes such as smoking or medications (like perindopril) that have cough as a side effect
When lung or heart conditions have been ruled out, an upper endoscopy or OGDS is often needed to assist in diagnosis and assess the severity of GERD. OGDS is relatively insensitive for diagnosing GERD, however the presence of erosive oesophagitis and/or Barrett’s oesophagus is strongly suggestive of GERD. Conversely, normal mucosa on endoscopy does not rule out the diagnosis of GERD. Ambulatory pH monitoring may be required to more accurately diagnose the condition.
The relationship between Helicobacter pylori (HP) and GERD is still unclear. Some studies show a lower prevalence of HP infection in patients with reflux symptoms or oesophagitis, suggesting a possible protective effect of HP infection.
General advice in reducing symptoms of GERD includes:
- Eat smaller and more frequent meals.
- Limit intake of acid-stimulating foods and beverages. Caffeine, antihistamines and menthol-containing cough drops all have a drying effect and should be avoided.
- Avoid lying down for at least three hours after eating, especially after dinner.
- Elevate the head when sleeping.
- Maintain an ideal body weight.
- Stop smoking.
- Avoid alcohol.
- Avoid tight belts or garments.
There are various medications to treat GERD, for example proton pump inhibitors like omeprazole, esomeprazole, pantoprazole, lansoprazole and dexlansoprazole which act to reduce stomach acid secretion. Home remedies like honey help to calm dry, persistent coughs.
Surgical reduction of a hiatus hernia with simple closure of the crura may also reduce reflux symptoms. Unfortunately the symptoms may recur in 50% of patients even after surgery.
By Dr Chieng Jin Yu, Medical Lecturer, Consultant Gastroenterologist and Hepatologist, Universiti Putra Malaysia (UPM).
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]