Chronic Cough Linked to Heartburn

If you have been coughing consistently for awhile, you might have what is referred to as chronic cough. Scientists are now finding that chronic cough is often associated with a heartburn condition. In other words, GERD – gastrointestinal reflux.

Testing patients with chronic cough

In a 2015 study from the Mayo Clinic, researchers tested 32 patients with chronic coughing along with another 32 patients with heartburn. They found that one-third of the chronic coughing patients also had what they referred to as “weak peristalsis with large breaks.” This means they had difficulty digesting food well.

Peristalsis is when the digestive tract has rhythms or waves that contract and relax. This allows food to be worked through the stomach and intestines during digestion. A person with weakened peristalsis will also typically have heartburn. This is because acids will leak back from the stomach into the esophagus.

The study also found that 81 percent of the patients with chronic cough and weakened peristalsis had extended acid exposure in their esophagus. This means that in many of the chronic cough patients, heartburn and acid reflux were connected with their coughing.

When these acids that leak back into the esophagus climb up to the throat region, they irritate the upper esophageal sphincter. They also irritate the bronchi and the throat region. This results in a weakening of the mucosal tissues within these areas, and that will often make a person cough.

GERD and chronic cough

In a review of research from the Department of Otolaryngology Head Neck Surgery at the UK’s Bradford Royal Infirmary, medical doctors confirmed their clinical observations that one of the two most prevalent causes for chronic coughing comes from gastroesophageal reflux, also called acid reflux or GERD.

The research reviewed clinical research dating back into the 1990s that has consistently found a correlation between GERD and chronic coughs. This is also consistent with research finding that asthma is also linked to GERD.

The research was published in the International Journal of Otolaryngology. The researchers also found (expected) correlations between chronic coughing and post-nasal drip syndrome. They determined that many patients with chronic coughing are being misdiagnosed because the doctor may not realize the link between acid reflux and coughing.

Ear Nose Throat clinics, the researchers stated, are now better prepared for finding these associations among patients. “Better diagnostic modalities, noninvasive tests, and high technology radiological and endoscopic innovations have made diagnosis of these difficult-to-treat patients relatively easier.”

A better sleeping position

Other research has found that this weakened peristalsis condition relates specifically to the condition of heartburn, especially when a person is in the supine position. This means laying on their back in bed. The best position to lay down when in bed for someone with weakened peristalsis and heartburn is to raise the head of the mattress up a little so that the neck is elevated above the plane of the stomach. This will help keep any acids from leaking up into the throat area and causing the chronic coughing.

To raise the mattress, consider putting something between the mattress and box springs, or something under the box springs. This can mean a board or other solid object to raise the height of the bed near the head. A well-supported pillow can also help keep the head and throat raised up.

REFERENCES:

Almansa C, Smith JA, Morris J, Crowell MD, Valdramidou D, Lee AS, DeVault KR, Houghton LA. Weak peristalsis with large breaks in chronic cough: association with poor esophageal clearance. Neurogastroenterol Motil. 2015 Mar;27(3):431-42. doi: 10.1111/nmo.12513.

Sylvester DC, Karkos PD, Vaughan C, Johnston J, Dwivedi RC, Atkinson H, Kortequee S. Chronic cough, reflux, postnasal drip syndrome, and the otolaryngologist. Int J Otolaryngol. 2012;2012:564852.

Ribolsi M, Balestrieri P, Emerenziani S, Guarino MP, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014 Jan;109(1):46-51. doi: 10.1038/ajg.2013.373.