Chronic cough and gastroesophageal reflux disease

Researchers from Rochester, New York, find that 4 to 6 weeks of a proton-pump inhibitor successfully diagnoses and treats most patients with GERD-related cough.

In this study, researchers evaluated proton-pump inhibitor therapy, with or without a prokinetic agent, in the diagnosis and treatment of gastroesophageal reflux disease (GERD)-related cough.

The team performed a review of their experience of 214 patients with a cough of 3 weeks, referred over a 3 and a half year period.

The cough was eliminated or markedly improved in 86% of patients after 4 weeks.

Chest

Their findings are published in the March issue of Chest.

Overall, the team identified 183 patients with chronic cough, these were included in the study. However, 31 patients were disqualified because of abnormal chest radiographic findings, inadequate follow-up, or cough being not the primary complaint.

Of the 183 patients, 56 were identified as having GERD-related cough.

The team prescribed these patients a once-daily dose of a proton-pump inhibitor.

In addition, the team added a prokinetic agent if esophageal dysfunction was suspected, or response was inadequate.

Patients who did not respond underwent 24-hour esophageal pH monitoring.

The research team found that GERD was the single cause of cough in 43% of patients. A further 52% had GERD plus another cause, and 5% patients had GERD with more than 2 causes.

The team also determined that 43% of patients had a cough only, while 57% had other symptoms of GERD.

Overall, proton-pump therapy was successful in 79% of patients.

The team found that 24 patients responded to proton-pump inhibitor therapy, and 18 patients responded when metoclopramide or cisapride was added. The remaining 2 patients responded to a histamine type-2 blocker or cisapride alone.

The cough was eliminated or markedly improved in 86% of patients after 4 weeks, and by 8 weeks in the remaining 6 patients.

The team found that 6 of the nonresponders had aspiration diagnosed by bronchoscopy.

Additionally, 4 patients had fundoplication recommended, and 2 patients responded to alternative interventions.

Drs Robert Poe and Michael Kallay concluded, "4 to 6 weeks of a proton-pump inhibitor alone or in combination with a prokinetic agent successfully diagnoses and treats 4 of 5 patients with GERD-related cough".

"24-hour esophageal pH monitoring will confirm the diagnosis in the others."

"These patients may be candidates for fundoplication."

"Nonresponders often aspirate as an additional aggravating factor."