How Long Can I Continue PPIs For Dry Cough?

Posted on Wed, 6 Aug 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 6 Aug 2014 Answered on

Tue, 2 Sep 2014 Last reviewed on

Question : Hi,
I have been taking PPIs for about 7 weeks now to control a dry cough. I believe the cough is slowly getting better. However, it hasn't completely healed. How long can I continue to take PPIs?

Also, I have previously asked this question but would like confirmation that it is OK to switch between different PPIs. I am wondering whether this decreases effectiveness because it takes a while for a single PPI to achieve its peak effect and also whether it might introduce different rebound effects. If taking 3 different PPIs, then there are potentially 3 different rebound effects to consider.

Thankyou.

Answered by Dr. Dr. Klerida Shehu (5 hours later)

Brief Answer:
Can switch...

Detailed Answer:
Hi XXXXXXX

First, PPIs can be used until symptoms are improved. There is no exact time limitation with regards to using PPIs for acid reflux.

If you had dry cough, then, should evaluate and confirm if it is really due to acid aspiration due to GERD.

If your symptoms improved when using PPIs, then, your dry cough is due to acid aspiration.

Usually, the use of Omeprazole alone for at least 8 weeks is enough to control GERD symptoms. Can switch from one PPIs to another. First, we wait for 2 weeks to see if any improvement. Then, can decide to switch to another PPIs.

Hope it answered to your queries!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (15 hours later)

Thanks Dr. Klerida,

Note the point about trying the PPI for two weeks. I have had the nasoendoscopy done which shows irritation but it's unclear the source (allergy, GERD or post nasal drip)

I have noticed some occasional pain similar to a scratching pain about 5-10 cms above the stomach where the oesophagus would be. This pain is there after about 5-6 weeks of PPI usage, could the PPI usage cause this? I would have thought that the PPIs should reduce acid reflux.

Should the occasional pain be evaluated further with gastroscopy?

Thanks.

Answered by Dr. Dr. Klerida Shehu (4 hours later)

Brief Answer:
PPIs are supposed to alleviate the symptoms...

Detailed Answer:
Hi,

PPIs are supposed to alleviate your symptoms; they won't cause this stratching pain.

Yes, your thought was right: PPIs should reduce acid reflux. You can repeat the upper endoscopy 8 weeks after starting PPIs to evaluate the progression and find out the cause to the pain you are actually having.

All the best!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (34 hours later)

Thanks Dr. Klerida,

My primary doctor advised not to do too many gastroscopies and not to do it for screening purposes as it isn't good to have the scope down the throat and also there is the effect of the anaesthetic.

Given that my last gastroscopy was done about a year ago, should I still proceed to do another one despite the effects of having it done?

Thanks,
Regards.

Answered by Dr. Dr. Klerida Shehu (7 hours later)

Brief Answer:
Upper endoscopy is necessary to exclude GERD...

Detailed Answer:
Hi back XXXXXXX

Please bare in mind that the side effects of upper endoscopy are minimal, where anaeshtetic's effects are the more serious. However, it happens in rare cases.

With regards to other side effects (i.e. throat, and others); there is no contraindication for upper endoscopy.

Furthermore, gastroenterologist will decide whether you need upper endoscopy after evaluating your health condition and improvements if you made.

If the symptoms won't improve although you are on PPIs, then, your lungs function should be further evaluated, but first, we should be sure that you are not having GERD anymore.

If you do not want to go for upper endoscopy, you can run barium test or esophageal pH monitoring.

Hope it helped!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (42 hours later)

Thanks Dr. Klerida,

I have visited my GP and he said to try taking the PPIs twice per day for about a week to see if there is any improvement first. Would you agree with this step first?

For the barium test, I am unsure how this could pick up GERD because I wouldn't expect the erosion of the throat/oesophagus walls to show up on the X-ray. Also, is the barium test roughly equal to CT scans in radiation exposure? In pH monitoring, is this an unpleasant procedure where the tube is passed down through the nose and would it be possible carry out normal routines and sleep with this monitoring?

Thanks very much,
Regards.

Answered by Dr. Dr. Klerida Shehu (8 hours later)

Brief Answer:
Continue the actual therapy first...

Detailed Answer:
Hi back XXXXXXX

I find it correct to take PPIs twice daily. In fact, you should be using them with such dosage since the beginning.

Regarding the tests, they all have their good and bad aspects.

Barium test (in Tredenleburg position) can identify reflux; it does not identify the erosion of upper GI organs walls. With regards to X-ray exposure, barium test is not equal to CT-scan in radiation exposure (around 1/14).

pH monitoring might seem to be a fastidious procedure, but, it is an excellent test in cases of reflux.

Now, as mentioned earlier, these two tests (barium test and pH monitoring) are alternatives in case you do not want to run upper endoscopy.

To my opinion, you should continue your actual therapy first. After 2 weeks, after re-evaluation, it will be decided whether you need to repeat upper endoscopy or run the above mentioned tests.

All the best!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar