Uncontrolled Acid Reflux

I have had an intermittent chronic cough for years.  I have asthma, acid reflux and allergies that all can cause the coughing.  For the last 3 months, I haven't been able to get the cough under control despite increasing treatments in all of the areas listed above.  I've been to a Gastroenterologist, Pulmonologist and ENT.  In the last couple weeks, I've had a couple rounds of bloodwork, a Barium Swallow, an upper EGD with biopsies, a throat scope by my ENT, a chest x-ray, a chest CT scan, an MRI, a sleep study and an upper 24 hr pH probe test (on PPI's).  

For the most part, the tests have come back good. The throat scope showed irritation of my vocal cords.  The pH probe shows I have acid coming up into my throat area.  I'm currently taking Dexilant 60 mg, Pepcid and have a Nissen Fundoplication that the Barium Swallow and EGD show appears to still be intact and in place.  I also still sleep on an incline and watch my diet.  My ENT is recommending that I add an additional high-dose PPI to my current treatment.  I worry about the long-term effects of this. Also, I haven't found even double dosages of PPI's to be very effective for the last couple years.

What other treatment options are available?  Are there questions I should be asking or other directions I should be looking for help.

Thanks for your advice.

[Ratnakar Kini, MD]

Hi,
I would suggest a repeat 24 hours pH monitoring test to see whether acid reflux is under control and surgery is successful.
PPI are relatively safe medications.
Lifestyle modifications also play an important role in the managment of acid reflux.
1.Weight reduction if obese
2. Avoiding coffee, chocolate, citrus, fatty food, spices, alcohol and smoking