GERD Cough: How Reflux Causes a Chronic Cough and What Helps

01How

How reflux causes a cough

• Oesophageal reflex: acid irritating the lower oesophagus triggers a cough through shared nerves.
• Micro-aspiration: tiny amounts of reflux reaching the throat and airways.
• Cough-reflux cycle: coughing increases pressure in the abdomen, which can cause more reflux.

02Symptoms

Symptoms of a reflux cough

• A dry, persistent cough lasting more than 8 weeks.
• Coughing after meals, when lying down or bending over.
• Coughing when talking or on waking.
• Heartburn or a sour taste, though often absent.
• Hoarseness, frequent throat clearing or a lump in the throat.

See laryngopharyngeal reflux (LPR) and lump in throat.

03Silent

Silent reflux and the throat

In laryngopharyngeal reflux, stomach contents reach the voice box and throat, often without heartburn. It causes hoarseness, throat clearing, a lump sensation, post-nasal drip feelings and cough. The throat lining is sensitive to even small amounts of acid and digestive enzymes.

See acid reflux sore throat.

04Risk

Risk factors

• Excess weight, especially around the abdomen.
• Large or late meals.
• Smoking and alcohol.
• Pregnancy.
• Hiatus hernia.
• Some medicines, such as certain blood pressure medicines and anti-inflammatories.

05Diagnosis

How it is diagnosed

A doctor considers reflux after ruling out other common causes of chronic cough, such as asthma, post-nasal drip and medicines like ACE inhibitors. A chest X-ray may be done. If symptoms persist or the diagnosis is uncertain, specialists may use 24-hour pH-impedance monitoring, which records reflux episodes and links them to coughs, or an endoscopy. ENT specialists may examine the throat with a small camera.

06Lifestyle

Lifestyle changes

• Eat smaller meals and avoid eating within 3 hours of bed.
• Raise the head of the bed by 10 to 20 cm.
• Lose excess weight.
• Stop smoking.
• Limit alcohol, coffee, chocolate, fatty and spicy food if they trigger symptoms.
• Avoid tight belts and bending after meals.

07Diet

Diet for reflux cough

There is no single reflux diet, but many people benefit from regular, moderate meals with vegetables, whole grains and lean proteins, and from reducing fried and fatty foods, large portions, fizzy drinks, alcohol and late-night eating. Keeping a food and symptom diary helps identify personal triggers.

See foods to avoid with acid reflux.

08Medicines

Medicines

Antacids and alginates relieve occasional symptoms. Proton pump inhibitors (PPIs) reduce acid and help people with typical reflux symptoms. However, trials show PPIs are less effective for chronic cough without heartburn, and European guidelines advise against their use for chronic cough without evidence of acid reflux. Alginates may help with non-acid reflux. A doctor should review treatment if there is no benefit after 8 weeks.

09Cough control

Breaking the cough cycle

Cough suppression techniques, such as swallowing, sipping water or gentle nose breathing when the urge arises, help reduce coughing. Speech and language therapy for chronic cough can help, as can treatment for cough hypersensitivity.

See post-viral cough.

10Night

Coughing at night

Reflux cough often worsens at night. Raising the head of the bed, sleeping on the left side, avoiding late meals and limiting alcohol in the evening help reduce night-time reflux.

11Children

Reflux and cough in children

Reflux is common in babies and usually harmless. In older children, reflux can occasionally cause cough, but asthma and post-nasal drip are more common causes. A doctor should assess a child with a chronic cough.

12Surgery

Is surgery ever needed?

Anti-reflux surgery is considered only for selected people with proven reflux that does not respond to treatment, after specialist testing. Outcomes for cough are less predictable than for heartburn.

13Timeline

How long until the cough improves?

Lifestyle changes and, where appropriate, medicines are usually tried for 8 to 12 weeks before judging their effect, because the throat and cough reflex take time to settle. A diary of cough, meals and sleep position helps you and your doctor see whether changes are working.

15Summary

Key points to remember

• Reflux is a common cause of chronic cough, often without heartburn.
• Coughing after meals or lying down suggests reflux.
• Lifestyle changes are the first step.
• PPIs help with typical reflux symptoms but less for cough alone.