Night cough and gastroesophageal reflux: what to do?
A common symptom, the cough can have several origins. Most of the time, the problem is in the lungs or in the ENT area. Coughing can also occur in an anxious person under the effect of stress. But it can also come from the digestive tract.
Faced with these multiple tables, it is not always easy to distinguish between things. "Patients are often referred to us by a pulmonologist or otolaryngologist who evoke a digestive origin of the cough," observes Dr. Gilles Macaigne.
Why is there this cough?
In gastroesophageal reflux disease (GERD), some of the stomach contents move up the esophagus abnormally. The natural acidity of these regurgitations causes burning between the stomach and the mouth, with heartburn being one of the main symptoms of reflux. By the way, acid reflux can inflame the esophagus (esophagitis) and irritate the throat. And that is what causes the cough.
How do you recognize a cough associated with GERD?
"It is usually a dry cough that starts after a meal. It is favored by the lying position," explains Dr. Macaigne.
This could explain why coughing spells occur at night (nocturnal cough). A persistent cough is not a sign of how bad reflux is, says your doctor.
How is gastric reflux disease diagnosed?
Sometimes patients are offered a trial treatment to treat the patient with antacid medications, proton pump inhibitors (PPIs). Treatment is given in double doses for eight weeks. It seems like a good idea: if the medications work and the cough has subsided, the patient does have the disease.
In reality, this test does not provide a reliable diagnosis. "If the treatment works, that does not mean that the reflux has been treated. There may be a placebo effect. It is safer to perform tests to document it," emphasizes the gastroenterologist.
Perform a fibroscopy
Endoscopy is the first of these tests. Under local or general anesthesia, a tube with a mini camera is inserted into the throat. This device will allow to visualize the state of the esophagus and stomach.
"Endoscopy will show us the factors that contribute to having gastroesophageal reflux, such as a hiatal hernia or an open mouth of the lower esophageal sphincter. It can also reveal the presence of esophagitis or endobrachiesophagus (EBO) or Barretts esophagus, which is a change in the mucous membrane linked to heartburn, "explains Dr. Macaigne.
If, despite the symptoms, this fibroscopy is normal, the diagnosis of gastroesophageal reflux is not ruled out.
Another test can be done: PHmetry. For 24 hours, the patient will have a tube placed in the lower part of their esophagus. Connected to an external box, this probe will record the secretion of acidity throughout the day.
"This test allows us, in particular, to see whether or not the patients cough correlates with acid reflux," specifies the gastroenterologist.
How to treat gastroesophageal reflux and get rid of this cough?
When the diagnosis of gastroesophageal reflux disease is established, treatment is started. The indicated drugs are proton pump inhibitors (PPIs) that reduce the acidity of the stomach. Treatment can be continued "at the lowest effective dose" for a few weeks.
At the same time, hygiene rules of life are recommended to the patient: limit acidic foods and carbonated drinks, respect a period of two to three hours between dinner and bedtime, lose weight and raise the head of the bed to reduce pressure in the abdomen.