GERD and Chronic Cough

GERD should be suspected as the cause of chronic cough whenever a patient complains of frequent episodes of typical gastrointestinal symptoms such as daily heartburn and regurgitation, especially when the chest radiograph or clinical picture suggests an aspiration syndrome. Alternatively, cough may be the only symptom of GERD; in prospective studies, such so-called silent GERD has accounted for 43% to 75% of cases. In the absence of gastrointestinal symptoms, chronic cough can be confidently attributed to GERD if the patient is a nonsmoker, is not taking an ACE inhibitor, and has a normal or near-normal chest radiograph, and asthma, upper airway cough syndrome, and nonallergic eosinophilic bronchitis have been ruled out; 92% of patients with silent GERD fit this clinical profile. Failure to obtain a history of nocturnal coughing does not exclude GERD as a cause of cough. When the chest radiograph is normal, cough from GERD most commonly occurs while the patient is awake and upright and it usually does not occur or is not noted at all during sleep.

The use of 24-hour esophageal pH monitoring can help confirm that GERD is causing a cough.1 Correlation of cough and reflux events is possible when patients keep a symptom diary during the esophageal pH monitoring session. The monitoring session findings can be considered consistent with GERD as the cause of chronic cough when reflux events (acid or alkaline) appear to trigger cough or when any reflux parameter falls out of the normal range. However, the conventional diagnostic indices of GERD (e.g., percentage of time that pH is less than 4.0) that gastroenterologists use to diagnose reflux esophagitis can be misleadingly normal in patients with cough from GERD. The test should be interpreted as normal only when conventional indices for acid reflux are within the normal range and no reflux-induced coughs are identified during the 24-hour monitoring study.1

1. Irwin RS: Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest 129(1 suppl):80S, 2006 [PMID 16428697]


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