Chronic Cough and Acid Reflux: Diagnosis and Treatment


Chronic cough can be caused by gastroesophageal reflux disease (GERD), or acid reflux, rather than a cold, and recently, there has been a tendency to promote gastroesophageal reflux disease (GERD) as the primary cause of chronic cough. However, research indicates that a significant proportion of patients who are believed to have GERD do not exhibit clinical reflux on pH testing.

While GERD has been demonstrated to have a role in chronic cough, it is likely to be just one of the factors and not the primary cause of idiopathic chronic cough. According to the U.S. Library of Medicine, GERD is a contributing factor in 25% or more cases of chronic cough. GERD cough is characterized by a dry cough that worsens at night and lasts for over 8 weeks.

You can read a comprehensive review on gastroesophageal reflux disease (GERD) and acid reflux at here.

Distinguishing between various causes of cough relies more on a comprehensive patient history and active listening than on technological devices. Patients with classic symptoms of gastroesophageal reflux disease (GERD) and cough tend to exhibit GERD-related cough.

Cough at night or after meals are typical signs associated with reflux-induced cough. Similarly, a patient’s history of GERD, heartburn, or regurgitation makes it easier to identify GERD as a possible cause. On the other hand, if a patient denies having GERD, regurgitation, belching, or other symptoms, it is unlikely that acid reflux is the primary cause of cough.

Some indicators that suggest a chronic cough may be due to acid reflux include:

  • Coughing predominantly at night or after meals
  • Coughing while lying down
  • A persistent cough that persists even in the absence of common causes such as smoking or taking medications (including ACE inhibitors) that can cause coughing as a side effect
  • Coughing without accompanying asthma or postnasal drip, or when chest X-rays show no abnormalities.

To eliminate or minimize the effects of GERD cough, you can make lifestyle adjustments such as maintaining a healthy weight, quitting smoking, elevating your head when lying down or sleeping (preferably with a wedge block), eating slowly, waiting 2-3 hours before lying down after eating, avoiding heavy meals before bed, and avoiding tight-fitting clothes.

Certain foods can also exacerbate GERD or acid reflux, so it is best to avoid alcohol, chocolate, onion, fatty foods, caffeine, mint, fried foods, garlic, and tomato sauce.

Despite ongoing research, the effectiveness of treatments for chronic cough remains uncertain. While reflux medication has been found to be beneficial for a subset of patients with chronic cough, many patients who are prescribed reflux medication empirically do not experience improvement, making it difficult to determine whether acid reflux treatment is an effective remedy for chronic cough related to GERD.

When the cause of cough is related to acid reflux, the most common treatment approach is to use proton pump inhibitors (PPIs). A 3-month trial of once or twice-daily PPIs is typically recommended as an empiric treatment. It is important to consult a gastroenterologist for an accurate diagnosis and appropriate treatment plan.

How can I contact gastroenterologist Dr. Zavos for an appointment?

Dr. Chris Zavos is a board-certified gastroenterologist and hepatologist, located in Thessaloniki Greece, and specifically in Kalamaria suburb, about 7 kilometres (4 miles) southeast of downtown Thessaloniki. His private office is at: Fanariou 8 street (near Aigaiou and Adrianoupoleos avenues), Kalamaria (Thessaloniki), Greece.

Thessaloniki International Airport is only 10 km away from his private office in Kalamaria and can be reached by taxi within 13 minutes from the airport.

Dr. Chris Zavos performs endoscopies at Bioclinic private hospital in downtown Thessaloniki (Mitropoleos 86 street).

You can contact Dr. Zavos at phone numbers: (+30)-6976596988 and (+30)-2311283833, or you can email him at Dr. Zavos responds to Greek and English languages.

Last update: 26 September 2023, 18:56


Gastroenterologist - Hepatologist, Thessaloniki

PhD at Medical School, Aristotle University of Thessaloniki, Greece

PGDip at Universitair Medisch Centrum Utrecht, The Netherlands

Ex President, Hellenic H. pylori & Microbiota Study Group