CareNow® - May 14, 2021

Does the thought of eating spicy foods send you running for the antacids? If you suffer from heartburn caused by acid reflux, you might be surprised to know you are not alone.

According to the American College of Gastroenterology, as many as 60 million Americans report experiencing heartburn at least once a month and more than 15 million Americans claim to be experiencing heartburn symptoms each day.

This is particularly concerning as experiencing heartburn more than twice a week can lead to gastroesophageal reflux disease (GERD), which can cause ulcers and permanent damage if left untreated.

With acid reflux and the related symptoms being such a widespread problem, it’s no surprise that more than $10 billion dollars are spent on antacids worldwide each year.

In this article, we will discuss acid reflux and break down one of the most common symptoms: a chronic cough. Continue reading to find out how you can reduce your risk of chronic acid reflux completely.

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What is acid reflux?

To best understand the link between acid reflux and a chronic cough, you need to know about the underlying mechanisms that ultimately cause the problem. In its most basic form, acid reflux can be defined as a condition that occurs when stomach acid used in the digestive system processes moves upward into the esophagus.

The acid eventually causes irritation to the soft tissue making up this muscular tube. This irritation is what ultimately causes the patient to experience heartburn. Heartburn is generally described by patients as a mild burning sensation in the chest. As mentioned above, if heartburn occurs frequently, a patient may be diagnosed with gastroesophageal reflux disease, commonly called GERD.

Unfortunately, not only does GERD carry with it a host of problems associated with the deterioration of the lining of the esophagus, it is also linked to increased risk of esophageal cancer. This is why it is important to be seen by a provider if you are experiencing heartburn occurring on a regular basis.

How acid reflux can be linked to chronic coughing

Now that you have an understanding of what causes acid reflux and its most common symptom, heartburn, let us take a look at chronic coughing which is another common symptom. A chronic cough is defined by the Mayo Clinic as a cough that lasts eight weeks or longer in adults, or four weeks in children.

While there are many potential causes of a chronic cough, there are two primary causes of a coughing that are linked to acid reflux. The first is the most simple and suggests that the cough is caused as a reflex of the body triggered by stomach acid rising into the esophagus. The cough in this instance is merely an effect of this acid moving up into somewhere it shouldn't be and the body trying to expel it.

The second cause of a chronic cough linked to acid reflux is laryngeal pharyngeal reflux, which is also known as LPR. This occurs when the reflux causes acid to move above the food pipe, causing tiny droplets of stomach acid to land in the voice box or throat. The irritation causes inflammation to occur, leading to symptoms like coughing, hoarseness, throat clearing or feeling that something is stuck in the throat.

Interestingly, LPR and heartburn are not always experienced at the same time. Since only a small amount of acid is needed to trigger LPR, many patients do not link chronic coughing with acid reflux. This can potentially make a chronic cough tied to acid reflux difficult to diagnose.

Diagnosing a chronic cough caused by acid reflux

Because a chronic cough can have many causes, and heartburn can be a key indicator, diagnosing the problem for someone not experiencing heartburn can prove difficult. If a patient is not experiencing heartburn, a provider must take a detailed case history and assess the individual’s symptoms.

Other indicators of a chronic cough being linked to acid reflux are:

  • coughing mostly occurring at night or directly after a meal
  • coughing that occurs when the patient is lying down
  • persistent coughing that occurs even when traditional causes are not present. These include things like smoking or taking medications where coughing is a side effect
  • coughing without asthma or post-nasal drip, or when an X-ray of the chest is normal

If a patient's case history does not reveal any of these to be true, a 24-hour esophageal pH test may be required. This test is used to measure the pH or amount of acid that flows into the esophagus from the stomach during a 24-hour period.

While this test may seem inconvenient, it is often necessary as there are many other potential causes of a chronic cough. A chronic cough can also be caused by things like asthma, respiratory tract infections, chronic bronchitis, postnasal drip, tobacco use and medications such as ACE-inhibitors with coughing as a known side effect.

Tips and treatments for preventing acid reflux

If a patient is diagnosed with a chronic cough that ultimately stems from acid reflux, a provider may suggest any of the following:

  • Avoid the drinks and food that typically cause GERD and acid reflux. Some of these include alcohol, chocolate, caffeine, heavily fried foods, acidic foods, overly fatty foods, onions and garlic.
  • Stick to a healthy diet and maintain a healthy weight. People who are overweight or obese are most likely to develop a cough associated with GERD.
  • Stop smoking. Smoking can affect the way the esophageal sphincter functions. Smoking is also the cause of several other serious health issues, and if you smoke, you should stop.
  • Elevate the head of the bed and increase the amount of time between when you eat and when you lie down at night. Consider getting an adjustable mattress, as raising the head and torso sections of your bed by six to nine inches can often make a substantial difference.

If you have a cough that could be considered chronic, and it does not seem to be improving, we recommend you contact CareNow® for medical attention. If the cough is severe, or you are experiencing multiple symptoms that are commonly associated with the COVID-19 virus, a trip to the emergency room may be warranted.

Before your appointment at CareNow®, be sure to use our Web Check-In® tool and avoid the waiting room.

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Disclaimer: Patients’ health can vary. Always consult with a medical professional before taking medication, making health-related decisions or deciding if medical advice is right for you.