Integrative Management of Chronic Cough Associated with Gastroesophageal Reflux Disease: Physiological and Psychogenic Perspectives

Abstract

Aims: This study investigates the association between gastroesophageal reflux disease (GERD) and chronic cough with psychogenic components, identifying both physiological and psychological mechanisms that contribute to symptom persistence. It also evaluates therapeutic strategies including pharmacological treatments, such as proton pump inhibitors (PPIs), baclofen, and neuromodulators, alongside behavioral interventions like cognitive-behavioral therapy (CBT). Study Design: Integrative literature review. Place and Duration of Study: Databases searched (PubMed, SciELO, BVS, LILACS, Medline) between March and June 2025. Methodology: This study followed PRISMA guidelines for integrative reviews. Searches were performed using descriptors including "Cough," "Gastroesophageal Reflux," "Psychogenic," and "Therapeutics." Studies were included if published between 2014 and 2024, freely available in full text, and methodologically robust (randomized controlled trials, systematic reviews, or well-defined observational studies). After applying eligibility criteria and qualitative analysis, 17 studies were selected for inclusion. Results: GERD-related chronic cough was found to involve both vagal-mediated reflexes and microaspiration, with esophageal hypersensitivity as a contributing factor. Psychogenic influences—such as anxiety, stress, and sensory hypervigilance—amplified symptom perception and limited response to acid suppression alone. PPIs showed modest effectiveness, particularly in non-acid or functional reflux cases. Adjunct therapies including baclofen, gabapentin, and CBT demonstrated improved symptom control, while Nissen fundoplication surgery was effective in selected refractory cases. Integrative treatment combining medical, surgical, and psychological approaches yielded the best outcomes. Conclusion: Chronic cough associated with GERD is a multifactorial condition requiring individualized, multidisciplinary treatment. Optimal management involves not only acid reflux control but also the inclusion of behavioral and neuromodulatory strategies. Future studies should further investigate these integrated therapeutic pathways.