In the absence of typical gastrointestinal symptoms, gastroesophageal reflux disease (GERD) can often be overlooked as the cause of chronic cough (CC).
Researchers from the Departments of Surgery and Medicine at the University of Massachusetts Medical School, Worcester, USA, have analyzed the outcomes of Nissen fundoplications (NF) for patients who failed medical therapy for CC attributable only to GERD (G-CC).
They performed a prospective outcome evaluation of 21 consecutive patients with G-CC undergoing NF from 1997 to 2000 at a tertiary care university hospital.
A total of 21 patients without prior antireflux surgeries had G-CC diagnosed by a clinical profile and 24-hour pH monitoring showing a cough-reflux correlation.
Respiratory symptoms alone were present in 53% of patients.
NF was performed when G-CC persisted despite intensive medical therapy, including an antireflux diet.
|Esophageal pH - a valuable tool for preoperative cough-reflux correlation |
Preoperatively, all patients underwent 24-hour pH monitoring, esophageal manometry, barium swallow, gastric emptying study, bronchoscopy, and upper endoscopy.
NF was utilized in all cases and laparoscopically in 18.
Before and after surgery, patients graded their cough severity using the Adverse Cough Outcome Survey (ACOS).
Quality of life was measured using the Sickness Impact Profile (SIP).
The researchers identified 18 patients (86%) who, postoperatively, reported an improvement of their cough.
G-CC was considerably improved in 16 of 21 patients (76%), with complete resolution being achieved in 13 patients (62%).
A mild to moderate improvement was found in 2 patients (10%).
Both patient-reported cough severity (ACOS) and quality of life (SIP) significantly improved early on (6-12 weeks) postoperatively. They also persisted during the long-term (1-year) follow-up.
The average length of stay in hospital was 1.78 days for the laparoscopic (n = 18) and 6.3 days for the open surgery (n = 3) groups.
Commenting on the findings, lead author YW Novitsky described 24-hour esophageal pH monitoring as a "valuable tool for preoperative cough-reflux correlation".
"Antireflux surgery is effective in carefully selected patients whose refractory CC is attributable only to GERD," he said.
"Nissen fundoplication controls the severity of cough and improves quality of life, while outcomes are further enhanced using laparoscopic procedures, with shorter hospital stays."