Cough as an extraintestinal manifestation of gastroesophageal reflux disease is a very difficult thing to diagnosis and treat. First of all, one needs to make the diagnosis. Typically patients have a history of gastroesophageal reflux disease with heartburn that has responded to conventional therapy, but cough persists. Patients will frequently see ear, nose and throat doctors and be treated for sinusitis and post-nasal drip without relief. Pulmonology consultation may lead to treatment for asthma or bronchitis. When nothing else is found, gastroesophageal reflux disease is usually assumed to be the culprit. The best way to diagnose the condition is to do a 24 hour pH study to see if the patient is truly experiencing acid reflux. In this test, a small catheter is inserted through the nose, into the distal esophagus. There is a pH sensing probe at the end of the esophagus, and it is left in for 24 hours. The patient leaves the endoscopy department with the small tip of the catheter exiting the nostril. The probe transmits data to a monitor worn on the waist. The next morning, the patient returns and the monitor is analyzed. If there is no acid present in the esophagus, then the cough is not from acid reflux.
If there is acid present in the esophagus, aggressive treatment should be started. Typically, it is more difficult to treat the extraintestinal manifestations of acid reflux, such as cough, than it is to treat heartburn.
While you should check with your doctor, the use of high-dose proton pump inhibitors (typically Nexium before breakfast and dinner) in combination with an H2 receptor antagonist (typically Pepcid or Zantac at bedtime) for at least two months will usually lead to improvement in cough that is caused by gastroesophageal reflux disease.
Read more about the symtoms of acid reflux mentioned in this post by clicking on this link.
