A persistent cough may be a symptom of chronic acid reflux, also known as gastroesophageal reflux disease, or GERD, which affects up to 20 percent of the U.S. adult population. Acid reflux can irritate the throat in ways that may trigger a cough when you are eating, but coughing while eating could be a sign of other conditions that warrant medical attention. If you suffer from acid reflux and find that you frequently cough when eating or swallowing, it's important to sort out the possible reasons and factors contributing to your cough, of which GERD may be one.
How GERD Causes Coughing
GERD is a common cause of chronic or persistent cough in all age groups. For some individuals, acid reflux coexists with or aggravates postnasal drip and asthma -- both of which are also common causes of chronic cough. Reflux can contribute to a cough when acid irritates and inflames the esophagus, causing nearby nerves to become more sensitive and apt to trigger the cough reflex. Heartburn or regurgitation indicate that GERD may be contributing to a cough. Cough can also occur when droplets of acid reach the voice box and windpipe. When acid refluxes all the way into the throat and onto the vocal chords, it's called laryngopharyngeal reflux, or LPR, which may be associated with coughing, throat clearing and hoarseness. Many people with LPR do not have heartburn.
Dysphagia refers to pain and difficulty swallowing. There are many potential causes, with severe GERD among them. Abnormal narrowing of the esophagus can be a complication of GERD over the long term, and sometimes this leads to coughing or episodes of "food bolus impaction," during which a mass of chewed food is caught in the throat without blocking the airways. This can sometimes require emergency treatment to remove the obstruction, though most episodes are resolved without medical intervention.
Another possible explanation for a GERD-related cough when eating is aspiration, which means that food goes down the windpipe instead of the esophagus. This happens to almost everyone at one time or another by accident, leading to the cough reflux and expulsion of the offending material. But chronic GERD can also be associated with aspiration and inflammation of the esophagus from exposure to acid gastric juices. Difficulty swallowing properly and diversion of food down the trachea can be the result.
If a chronic cough is triggered persistently by eating and is reducing your quality of life, your doctor may administer certain tests. If GERD is suspected as the reason behind a suspicious chronic cough, or a cough when eating, one or more tests may be administered. Esophageal pH testing measures acid exposure; a tube equipped with an electronic monitor is passed through the nose or mouth to the stomach to measure acid exposure over a 24-hour period. Vocal cords may be examined for water retention and enlargement of capillaries. An endoscopy -- a procedure in which a tube equipped with a light and camera is inserted to provide images of the esophagus -- may also be performed.
Next Steps and Precautions
Let your doctor know if eating or swallowing triggers a persistent cough. According to research published in the May 2006 issue of "Journal GI Motility Online," chronic cough can have more than 20 causes, and there may be more than one cause involved in the majority of cases. In some cases, chronic coughing caused by acid reflux responds to a combination of lifestyle changes such as losing weight and acid-neutralizing medications called proton pump inhibitors, or PPIs, which are available both over the counter and by prescription.
Medical advisor: Jonathan E. Aviv, M.D., FACS
- American Gastroenterological Association: Gastroesophageal Reflux Disease (GERD)
- Journal of Otolarynology: Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist
- MedGenMed: Atypical Manifestations of Gastroesophageal Reflux Disease
- Canadian Journal of Gastroenterology: Review of Food Bolus Management
- Journal of Gastroenterology & Hepatology: Food Bolus Impaction
- Goyal and Shaker GI Motility Online: Gastroesophageal Reflux and Chronic Cough
- Annals of Thoracic Medicine: Pulmonary Manifestations of Gastroesophageal Disease
- Therapeutics and Clinical Risk Management: Management of Laryngopharyngeal Reflux With Proton Pump Inhibitors