Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the esophagus and stomach. Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD. Doctors believe that some people suffer from GERD due to a condition called hiatal hernia. In most cases, GERD can be relieved through diet and lifestyle changes; however, some people may require medication or surgery.
GERD related chronic cough is known as one of the GERD related extraesophageal manifestation (suggested to refer to Montreal classification). All non-smoking patients with chronic cough but normal chest X rays and are not taking ACEI, should be suspected of GERD related chronic cough.
Poe et al. found that GER alone accounted for cough in 13% of their study population.
TWO mechanisms:
(a) Irritation of the respiratory tract by aspiration
(b) Stimulation of an esophageal-bronchial cough reflex (Vagal mediated)
Low specificity of studies to diagnose chronic cough:
- OGDS showed only 15% esophagitis in 45 patients with chronic cough by Baldi et al.
- 24-h esophageal pH monitoring has low specificity in diagnosing abnormal esophageal acid exposure in patients with reflux associated chronic cough. 53% of the patients had pathological reflux. by Baldi et al.
American College of Gastroenterology recommends that PPI should be tried to treat extraesophageal symptoms in patients who also have typical symptoms of GERD.
Chronic cough can be an extraesophagical manifestación of GERD. This is being known for a longitud time and the Montreal definition of GERD considered that as an specific way of GERD. Several updates about that can easily bé found at Pubmed.
Yes it certainly can be but there is a long list of differential diagnoses that include respiratory and ENT causes.
For patients considering surgery for GORD with confirmed PH testing who also have a cough it is always worth stating that cough resolution can be more unpredictable (closer to 50:50 chance) and can take a longer period of time.
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