Coughing is a common symptom that can have many different causes. One potential cause is acid reflux, also known as gastroesophageal reflux disease (GERD). Acid reflux occurs when stomach acid flows back up into the esophagus and irritates the lining of the esophagus, triggering a cough reflex. Knowing the signs and symptoms of an acid reflux cough can help you determine if this might be the underlying cause of your coughing.
What are the signs and symptoms of an acid reflux cough?
Here are some of the most common signs and symptoms that your cough may be linked to acid reflux:
- Chronic cough: If you’ve had a persistent cough for more than a few weeks, acid reflux may be the cause.
- Worsening cough at night: The cough often gets worse when lying down or sleeping.
- Cough after eating: You may notice coughing spells right after meals.
- Sour taste: You may have a sour or bitter taste in your mouth from acid.
- Hoarse voice: The constant coughing can strain your vocal cords.
- Sore throat: Acid reflux can cause soreness and irritation in the throat.
- Trouble swallowing: Some people feel like food gets stuck in their throat.
- Lump in the throat sensation: You may constantly feel like you have phlegm or a lump in your throat.
- Feeling like you need to clear your throat: The need to frequently clear your throat can signal reflux.
If you have an otherwise unexplained chronic cough and you’re experiencing some of these other symptoms, it’s quite possible acid reflux is to blame.
What causes acid reflux?
Acid reflux occurs when the lower esophageal sphincter (LES), the ring of muscle that separates the esophagus from the stomach, becomes weakened or relaxes inappropriately. Normally, the LES tightens to prevent food and acidic stomach juices from flowing back up. But when it malfunctions, acidic digestive juices can regurgitate up into the esophagus. This is what leads to acid reflux symptoms like coughing.
Some of the main factors that can contribute to acid reflux and cause the LES to dysfunction include:
- Hiatal hernia: This is when part of the stomach protrudes up through the diaphragm, allowing acid to more easily flow into the esophagus.
- Pregnancy: Hormonal changes and increased pressure from the uterus can promote reflux.
- Obesity: Extra weight presses on the stomach and can force open the LES.
- Smoking: This impairs muscle function in the LES.
- Some medications: Drugs like antidepressants, pain relievers, sedatives, and calcium channel blockers can relax the LES.
- Large meals: Overeating causes the stomach to be distended, pushing up on the LES.
- Fatty, spicy, or acidic foods: These can irritate the esophagus or stomach.
- Eating right before bed: Lying down right after meals makes reflux more likely.
How is an acid reflux cough diagnosed?
If acid reflux seems like a possible cause of your chronic cough, your doctor will likely want to confirm the diagnosis through testing. Some common diagnostic tests include:
- Endoscopy: A small camera on a flexible tube is used to visually examine the esophagus. This allows your doctor to see if you have esophagitis or inflammation caused by acid reflux.
- pH monitoring: A small sensor is placed in your esophagus to track acid levels over 24 hours. Abnormal acid levels point to reflux.
- Impedance testing: This measures the flow of liquid and gas in the esophagus to detect any reflux episodes.
- Barium swallow: You swallow a liquid containing barium, which coats the lining of the esophagus. X-rays are then taken to look for damage from acid.
- Biopsy: A tissue sample may be taken from your esophagus to test for Barrett’s esophagus, a complication of chronic acid reflux.
Your doctor will likely also review your medical history and perform a physical exam looking for signs of acid reflux. Treatment can then be tailored to address the underlying cause of your reflux.
How is an acid reflux cough treated?
The goals of treatment are to relieve your coughing, heal any damage to your esophagus, and prevent further reflux episodes. Common treatment approaches include:
- Antacids: Over-the-counter antacids like Tums and Rolaids provide quick relief by neutralizing stomach acid.
- H2 blockers: These medications reduce acid production. Brand names include Pepcid, Zantac, and Axid.
- Proton pump inhibitors: The most potent medications for reducing acid production. Brand names are Nexium, Prilosec, and Prevacid.
- Prokinetics: These help strengthen the LES and improve stomach emptying. Metoclopramide is an example.
- Lifestyle changes: Losing weight if needed, avoiding trigger foods, not eating before bed, etc.
- Surgery: For those who don’t respond to other treatments, surgery can strengthen the LES.
Your doctor may prescribe a combination of medication and lifestyle changes. Significant improvement of acid reflux and coughing typically occurs within 4-8 weeks with appropriate treatment.
How can I prevent acid reflux?
Making certain lifestyle modifications can go a long way towards preventing acid reflux episodes and controlling symptoms:
- Maintain a healthy weight
- Avoid tight-fitting clothes
- Stop smoking and limit alcohol
- Limit acidic foods like citrus, tomatoes, and coffee
- Avoid large, high-fat meals
- Don’t eat within 3 hours before bed
- Raise the head of your bed 6-8 inches
- Loosen your belt; wear loose-fitting clothing
Medications like antacids can also be used preventatively to control acid production and allow damaged tissue to heal when symptoms flare up. Let your doctor know if you frequently experience acid reflux symptoms like coughing so a long-term management plan can be developed.
When should I see a doctor?
You should make an appointment with your doctor if:
- You’ve had a persistent cough for over a week
- Your cough is worsening or interfering with daily life
- You cough up blood-tinged mucus
- You have trouble breathing or swallowing
- You have chest pain along with coughing
- You have a fever along with coughing
- Your cough returns after a prior treatment course
A chronic cough can sometimes be a sign of a more serious underlying problem. It’s important to get an accurate diagnosis so proper treatment can begin. An acid reflux cough may respond well to lifestyle changes and medications, but coughs unrelated to reflux could require completely different therapies.
Key Points
- Acid reflux is a common cause of chronic cough. Symptoms like a sour taste, sore throat, and hoarseness after eating clue you in.
- Various tests like endoscopy and pH monitoring help diagnose reflux. Treatment involves medications, diet and lifestyle changes.
- Prevention through healthy weight, not smoking, eating small meals, and not lying down after eating is key.
- See a doctor for any persistent unexplained cough to obtain an accurate diagnosis and treatment.
The Bottom Line
If you have a nagging cough that persists for weeks on end, acid reflux could be the culprit behind it. Paying attention to when your cough is worse and any accompanying symptoms can help determine if reflux is responsible. Work with your doctor to confirm the diagnosis through testing and implement lifestyle changes, medication, or other therapies to control your symptoms for good.