Hacking Cough With GERD

Hacking Cough With GERD

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GERD can cause chronic cough.

Siri Stafford/Lifesize/Getty Images

Gastroesophageal reflux disease is a common upper gastrointestinal disease in the Western world, with up to 20 percent of people experiencing symptoms at least once a week. To facilitate its diagnosis and treatment, doctors have divided GERD into esophageal and extra-esophageal syndromes. Heartburn and regurgitation, the most common symptoms of GERD, are classified as esophageal symptoms. Extra-esophageal signs and symptoms include chronic sore throat, eroded dental enamel, recurrent sinus and ear infections, asthma, hoarseness and a persistent cough.

Airway Irritation

GERD is caused by acidic stomach contents going into your esophagus, which is the tube connecting your throat and stomach. When the acid reaches your upper esophagus, you might inhale it into your larynx and airways, which triggers irritation and cough. GERD, asthma and postnasal drip, alone or in combination, are responsible for more than 90 percent of chronic coughs, according to a study published in the August 1999 issue of “Chest.” In people with asthma, GERD may be the driving force behind a persistent cough and wheezing. Conversely, asthma can aggravate GERD by altering the pressures within your chest cavity and increasing the frequency or volume of acid reflux.

Nerve Stimulation

Many of the actions of your internal organs are controlled by your vagus nerve, which arises from your brainstem and wanders throughout your body. In addition to controlling many of your bodily functions, the vagus nerve returns messages from your organs to your brain. In the April 2009 issue of “Pulmonary Pharmacology and Therapeutics,” researchers reviewed a growing body of evidence showing that acid reflux stimulates branches of the vagus nerve in your lower esophagus. This, in turn, generates a cough reflex within your brainstem.

Blocking Acid May Not Relieve Cough

Treating GERD with acid-blocking drugs may not relieve the hacking cough associated with acid reflux, according to a 2012 review in “The Open Respiratory Journal.” Proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid), and H2 blockers, such as cimetidine (Tagamet) and ranitidine (Zantac), may reduce acid production, but they do not stop reflux. Many of the other substances in non-acid reflux -- pepsin and bile salts, for example -- can still cause airway irritation or vagal stimulation.


While GERD is a common cause of chronic cough, it can be difficult to link acid reflux to a hacking cough. Other conditions, such as asthma, postnasal drip or medication-induced cough, must be ruled out and treated, if necessary. This process should be guided by your doctor. Because acid-blocking therapy may not relieve your cough, you may need to take other stops to reduce reflux. You may need to lose weight, stop smoking, eat smaller meals, eat less fat, raise the head of your bed, and avoid foods that aggravate your GERD, such as caffeine, alcohol, peppermint or chocolate.


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