GERD-Induced Bronchitis

Pathophysiological Mechanisms

GERD can stimulate the afferent limb of the cough reflex by irritating the upper respiratory tract without aspiration, such as the larynx, in patients with gastroesophageal reflux disease 1, 2
GERD can irritate the lower respiratory tract through microaspiration or macroaspiration of gastric contents in individuals with GERD 1, 2
An esophageal-bronchial cough reflex exists where refluxate into the distal esophagus alone can stimulate cough through neural pathways in patients with GERD 1, 2
Bronchoscopy may reveal airway signs consistent with aspiration, such as hemorrhagic tracheobronchitis and erythema of subsegmental bronchi, in patients with GERD-induced bronchitis 2

GERD-induced bronchitis can present as a cough-phlegm syndrome similar to chronic bronchitis from cigarette smoking in patients with GERD 1, 3
The cough may be either productive or dry in individuals with GERD-induced bronchitis 1, 3
GERD can be "silent" from a GI standpoint in up to 75% of cases, meaning patients may have no typical reflux symptoms like heartburn, and may present with respiratory symptoms only 1, 3
Aspiration syndromes associated with GERD include bacterial pneumonia, chemical pneumonitis, recurrent bacterial pneumonias, bronchiectasis, and tracheobronchitis in patients with GERD 1, 3

Studies have shown that GERD is a contributing factor in 5-41% of chronic cough cases referred to specialty clinics, according to the American Thoracic Society 4
Patients with a new diagnosis of GERD have an increased likelihood (OR, 1.7; CI, 1.4-2.1) of subsequently being diagnosed with cough in the following 12 months, as reported by the American College of Gastroenterology 5
Regurgitation has been identified as a strong predictor of cough (OR, 1.71; 99% CI, 1.20-2.45) in population-based studies, according to the American College of Chest Physicians 5

Bronchoscopy may reveal signs consistent with aspiration, such as hemorrhagic tracheobronchitis, in patients with GERD-induced bronchitis 2
Chest imaging studies may demonstrate parenchymal abnormalities consistent with aspiration in individuals with GERD-induced bronchitis 2

The American College of Gastroenterology recommends intensive antireflux therapy for chronic cough associated with GERD 6
Positional therapy, such as elevating the head of bed and avoiding meals within 3 hours of bedtime, can help alleviate symptoms of GERD-induced bronchitis, as suggested by the American College of Gastroenterology 6

Cough exacerbated by meals and positional worsening (nighttime) are characteristic of reflux-related cough in patients with GERD-induced bronchitis 6
Resolution of symptoms during travel or dietary changes may suggest GERD as the underlying cause of bronchitis, according to the American College of Gastroenterology 6

Symptoms present despite normal chest radiograph 7
24-hour esophageal pH monitoring remains the single best test to establish a cause-effect relationship between GERD and respiratory symptoms 7, 8

The American College of Gastroenterology recommends intensive antireflux therapy for chronic cough associated with GERD, including proton pump inhibitor therapy, positional therapy, antireflux diet modifications, and prokinetic therapy if initial treatment is insufficient 9
Laparoscopic antireflux surgery has shown 85-86% improvement rates in chronic cough at 6-12 months post-surgery 9