Is GERD related to cough?

Persistent dry cough… Could it be due to stomach acid?

Why Won't the Cough Stop?

A cough is essentially a defensive reflex of the body. When the bronchial tubes are irritated, our body uses coughing as a signal to expel the irritant. That's why we cough when we have a cold, and people with sensitive airways easily cough even due to dust or cold air.

However, the problem arises when the cough persists even after a cold has fully resolved and the lungs are clear. This is especially true for dry coughs that appear particularly when lying down at night, or after meals. Despite visiting multiple hospitals, with no abnormalities found in the lungs and no allergies diagnosed, the cough simply won't stop. In such cases, you should suspect an unexpected organ: the stomach. Many people, more than you might think, overlook this because they don't realize that the cause of their cough could be acid reflux.

Why Does Acid Reflux Cause Coughing?

Stomach acid in the stomach is actually a very powerful acid. While essential for digestion, it causes problems if it leaks out of the stomach. Specifically, if this acid ascends past the esophagus to the laryngopharynx or near the trachea, it irritates the throat and sends a 'cough' signal to the brain via nerves.

Pathways of Cough Development

Coughing typically occurs through two main pathways:

• Direct Irritation: This occurs when acid ascends to the upper esophagus, larynx, or vocal cords, physically irritating the mucous membranes. In such cases, patients often experience a scratchy throat, frequently clear their throat, or wake up with a hoarse voice in the morning. The cough is usually a dry cough, meaning a hacking type without phlegm.
• Reflex Irritation: Even if acid doesn't reach the upper esophagus, the nerves running along the esophageal wall (especially the vagus nerve) react sensitively and send a 'cough' signal to the brain. In these cases, the acid doesn't actually touch the airway, but a cough is still triggered.

Endoscopy is Normal, but You Still Have a Cough?

This is where many people get confused. "I had an endoscopy, and they said there was no inflammation in my esophagus. So it's not reflux, right?" This is highly likely to be NERD, or Non-Erosive Reflux Disease. In this condition, there are no visible lesions in the esophagus, but it reacts sensitively to even small amounts of acid. It's not just acid; digestive substances like pepsin or bile can also ascend.

Another form is Laryngopharyngeal Reflux (LPR). This occurs when a very small amount of stomach acid ascends to the vocal cords or larynx, leaving no trace in the esophagus but causing symptoms only in the throat or vocal cords. Patients in such cases report symptoms like "a lump in the throat sensation," "difficulty swallowing saliva," or "frequent hoarseness." And, naturally, coughing can also accompany these. In other words, a normal endoscopy does not rule out acid reflux. The issue depends on how far up the acid has ascended and how sensitively the body reacts to it.

How Does It Differ from Psychogenic Cough?

Another point to address here is the distinction from psychogenic globus sensation or stress-induced cough. A psychogenic cough worsens with emotional states, and patients often experience a persistent sensation of something being stuck in their throat throughout the day. It may even tend to improve while eating. This is a result of sensory misinterpretation by the brain, essentially a state of sensory hypersensitivity sending cough signals.

In contrast, acid reflux-induced cough has a different pattern. If the cough is severe after meals, particularly bothersome when lying down, causes extreme discomfort or hoarseness upon waking in the morning, or shows no response to general cold medications or inhalers, these patterns provide a basis to suspect reflux-induced cough.

How Can It Be Diagnosed and Treated?

Acid reflux-induced cough cannot be identified through a simple chest CT or bronchoscopy. Therefore, it is typically diagnosed through 24-hour esophageal pH monitoring, laryngoscopy, or a PPI test. The PPI test involves taking proton pump inhibitors for about two weeks to see if the cough improves.

Treatment typically involves proton pump inhibitors (PPIs), alginate preparations, and lifestyle modifications. These include not lying down within 2 hours after a meal, reducing coffee and carbonated drinks, and elevating the head slightly during sleep. From a traditional Korean medicine perspective, this is viewed as 'Weigi Sangyeok' (逆氣上逆), a phenomenon where the stomach's qi ascends, and treatments like Cheongyeol Gangyeok (clearing heat and descending qi) and Hwadarm Jihae (resolving phlegm and relieving cough) may be combined. Especially when symptoms become chronic and both the gastrointestinal and respiratory systems are sensitized, combining acupuncture or herbal medicine to regulate autonomic nervous system balance can be even more beneficial.

It Might Not Be Your Lungs, But Your Stomach

When people hear the word 'cough,' most immediately think of the lungs. However, the phenomenon of coughing is merely a way for the body to express that 'something is being irritated.' If your cough persists for a long time, shows no specific abnormalities in tests, doesn't respond well to medication, and is particularly severe after meals, when lying down, or in the morning, it might be due to your 'stomach.' It's time to look beyond just the respiratory system and understand the interconnectedness within your body. Seek out the true cause that your cough is trying to tell you. The answer, more often than you might think, could be found further down, not higher up.

#GERD #AcidRefluxCough