Gastro-Oesophageal Reflux Disease (GORD) and Chronic Cough

  • Lorcan McGarveyEmail author
  • Kian Fan Chung


Gastro-oesophageal reflux disease (GORD) as a syndrome arose from the attempt to understand peptic symptoms and pathology in the upper GI tract. Extra-oesophageal manifestations, such as LPR and airway reflux (discussed in other chapters in this volume) were initially unrecognised. In this chapter ‘classic’ GORD and its relationship or otherwise to the airways is discussed.


  1. 1.
    Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease (GERD) – a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Richter JE, Rubenstein JH. Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology. 2018;154:267.CrossRefPubMedGoogle Scholar
  3. 3.
    Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008;371(9621):1364–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Morice AH, Fontana GA, Sovijarvi AR, et al. The diagnosis and management of chronic cough. Eur Respir J. 2004;24:481–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:80S–94S.CrossRefPubMedGoogle Scholar
  7. 7.
    Morice AH, McGarvey L, Pavord I, British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults. Thorax. 2006;61(Suppl 1):i1–24.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Stanghellini V. Relationship between upper gastrointestinal symptoms and lifestyle, psychosocial factors and comorbidity in the general population: results from the domestic/international gastroenterology surveillance study (DIGEST). Scand J Gastroenterol Suppl. 1999;231:29–37.PubMedGoogle Scholar
  10. 10.
    Merati AL. Reflux and cough. Otolaryngol Clin N Am. 2010;43(1):97–110.CrossRefGoogle Scholar
  11. 11.
    Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179–87.e3.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Aguero GC, Lemme EM, Alvariz A, Carvalho BB, Schechter RB, Abrahao L Jr. Prevalence of supraesophageal manifestations in patients with gastroesophageal erosive and non-erosive reflux disease. Arq Gastroenterol. 2007;44:39–43.CrossRefPubMedGoogle Scholar
  13. 13.
    McGarvey LP, Heaney LG, Lawson JT, et al. Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax. 1998;53:738–43.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Rafferty G, Mainie I, McGarvey LPA. Respiratory and laryngeal symptoms secondary to gastro-oesophageal reflux. Frontline Gastroenterol. 2011;2(4):212–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Irwin RS, Curley FJ, French CL. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis. 1990;141:640–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Everett CF, Morice AH. Clinical history in gastroesophageal cough. Respir Med. 2007;101(2):345–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980;65(2):256–67.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Moayyedi P, Preston C. Antacids and lifestyle advice for reflux oesophagitis and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2001;(4).Google Scholar
  19. 19.
    Kahrilas PJ. Smoking and oesophageal reflux disease. Eur J Gastroenterol Hepatol. 2000;12:837–42.CrossRefPubMedGoogle Scholar
  20. 20.
    Phua SY, McGarvey LP, Ngu MC, Ing AJ. Patients with gastro-oesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity. Thorax. 2005;60:488–91.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Stovold R, Forrest IA, Corris PA, Murphy DM, Smith JA, Decalmer S, Johnson GE, Dark JH, Pearson JP, Ward C. Pepsin, a biomarker of gastric aspiration in lung allografts: a putative association with rejection. Am J Respir Crit Care Med. 2007;175:1298–303.CrossRefPubMedGoogle Scholar
  22. 22.
    Grabowski M, Kasran A, Seys S, Pauwels A, Medrala W, Dupont L, Panaszek B, Bullens D. Pepsin and bile acids in induced sputum of chronic cough patients. Respir Med. 2011;105:1257–61.CrossRefPubMedGoogle Scholar
  23. 23.
    Ing AJ, Ngu MC, Breslin AB. Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. Am J Respir Crit Care Med. 1994;149:160–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Patterson RN, Johnston BT, Ardill JE, Heaney LG, McGarvey LP. Increased tachykinin levels in induced sputum from asthmatic and cough patients with acid reflux. Thorax. 2007;62:491–5.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Chang AB, Gibson PG, Ardill J, McGarvey LP. Calcitonin gene-related peptide relates to cough sensitivity in children with chronic cough. Eur Respir J. 2007;30:66–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Field SK, Evans JA, Price LM. The effects of acid perfusion of the esophagus on ventilation and respiratory sensation. Am J Respir Crit Care Med. 1998;157:1058–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Javorkova N, Varechova S, Pecova R, et al. Acidification of the oesophagus acutely increases the cough sensitivity in patients with gastro-oesophageal reflux and chronic cough. Neurogastroenterol Motil. 2008;20(2):119–24.PubMedGoogle Scholar
  28. 28.
    Houghton LA, Lee AS, Badri H, DeVault KR, Smith JA. Respiratory disease and the oesophagus: reflux, reflexes and microaspiration. Nat Rev Gastroenterol Hepatol. 2016;13(8):445–60.CrossRefPubMedGoogle Scholar
  29. 29.
    Smith JA, Decalmer S, Kelsall A, McGuinness K, Jones H, Galloway S, Woodcock A, Houghton LA. Acoustic cough-reflux associations in chronic cough: potential triggers and mechanisms. Gastroenterology. 2010;139(3):754–62.CrossRefPubMedGoogle Scholar
  30. 30.
    Kahrilas PJ, Altman KW, Chang AB, Field SK, Harding SM, Lane AP, Lim K, McGarvey L, Smith J, Irwin RS, CHEST Expert Cough Panel. Chronic cough due to gastroesophageal reflux in adults: CHEST guideline and expert panel report. Chest. 2016;150(6):1341–60.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kastelik JA, Redington AE, Aziz I, Buckton GK, Smith CM, Dakkak M, Morice AH. Abnormal oesophageal motility in patients with chronic cough. Thorax. 2003;58(8):699–702.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Patterson RN, Johnston BT, MacMahon J, Heaney LG, McGarvey LP. Oesophageal pH monitoring is of limited value in the diagnosis of “reflux-cough”. Eur Respir J. 2004;24:724–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005;54:449–54.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Patterson N, Mainie I, Rafferty G, McGarvey L, Heaney L, Tutuian R, Castell D, Johnston BT. Nonacid reflux episodes reaching the pharynx are important factors associated with cough. J Clin Gastroenterol. 2009;43(5):414–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Herregods TV, Pauwels A, Jafari J, Sifrim D, Bredenoord AJ, Tack J, Smout AJ. Determinants of reflux-induced chronic cough. Gut. 2017;66:2057.CrossRefPubMedGoogle Scholar
  36. 36.
    Ours TM, Kavuru MS, Schilz RJ, Richter JE. A prospective evaluation of oesophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Am J Gastroenterol. 1999;94(11):3131–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Kiljander TO, Salomaa ERM. Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole. Eur Respir J. 2000;16:633–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Baldi F, Cappiello R, Cavoli C, Ghersi S, Torresan F, Roda E. Proton pump inhibitor treatment of patients with gastroesophageal reflux-related chronic cough: a comparison between two different daily doses of lansoprazole. World J Gastroenterol. 2006;12(1):82–8.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Faruqi S, Molyneux ID, Fathi H, Wright C, Thompson R, Morice AH. Chronic cough and esomeprazole: a double-blind placebo-controlled parallel study. Respirology. 2011;16:1150–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2011;(1):CD004823.Google Scholar
  41. 41.
    Kahrilas PJ, Howden CW, Hughes N, Molloy-Bland M. Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease. Chest. 2013;143(3):605–12.CrossRefPubMedGoogle Scholar
  42. 42.
    Shaheen NJ, et al. Randomised clinical trial: high-dose acid suppression for chronic cough - a double-blind, placebo-controlled study. AlimentPharmacolTher. 2011;33(2):225–34.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical SciencesQueen’s UniversityBelfastUK
  2. 2.Airway Disease SectionNational Heart and Lung Institute, Imperial College LondonLondonUK
  3. 3.Royal Brompton HospitalLondonUK

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