Chronic Cough as the Sole Presenting Manifestation of Gastroesophageal Reflux

Abstract

Nine patients complaining only of chronic cough of unknown cause were prospectively studied with prolonged esophageal pH monitoring (EPM) before and after cough had disappeared as a complaint in order to determine if and why gastroesophageal reflux (GER) was causing their coughs. Coughs disappeared as a complaint an average of 161 +/- 75 days after medical therapy for GER. Comparisons of pretreatment and post-treatment EPM data revealed the following: numbers of coughs (p = 0.029), total refluxes (p = 0.001), refluxes greater than or equal to 5 min (p = 0.019), and reflux-induced coughs (p = 0.005) had significantly decreased in the distal esophagus, and total refluxes (p = 0.05) had significantly decreased in the proximal esophagus. During the entire study period, the number of coughs were significantly correlated with the number of total refluxes (p = 0.039), longest reflux (p = 0.019), number of refluxes greater than or equal to 5 min (p = 0.006), and percent of total time that pH was less than 4 (p = 0.017) in the distal esophagus. On the basis of these results, we conclude that (1) cough can be the sole presenting manifestation of GER, and it gradually responds to standard GER therapy; (2) prolonged EPM is safe, well-tolerated, and extremely useful in diagnosing clinically silent GER; (3) the mechanism by which GER causes cough is related to a critical number and/or duration of reflux episodes in the distal and/or proximal esophagus.

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

“…Additionally, esophageal pH monitoring may be the only method of diagnosing GER in up to 32% of patients with reflux-induced cough (29). As symptoms of GER, such as heartburn, are frequently absent in patients with reflux-induced cough (21,30), therapeutic trials may be less useful if no symptoms of GER are present. The ReQuest is a valid and reliable tool for measuring GER symptoms (15), but other methods are required for the objective assessment of symptom severity and patient response to treatment.…”

Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole

“…cough goes away after specific therapy aimed at its cause) was not utilized at the inclusion. Secondly, it has been shown that GOR can be the cause of chronic cough even when the conventional variables in the pH monitoring are normal, if the cough is associated with a reflux episode [6]. Since we wanted to be certain that all the patients who were randomized really had GOR, these traditional variables were used to classify the patients.…”

Tachykinins and airway microvascular leakage induced by HCl intra-oesophageal instillation

“…This increase was largely prevented by the tachykinin NK 1 and NK 3 receptor antagonists SR 140333 and SR 142801 (1-10 mg?kg -1 ). These results suggest that protein extravasation in the airways, as induced by intraoesophageal HCl infusion, is mainly dependent on the release of tachykinins, and that both NK 1 Gastro-oesophageal reflux is a common clinical disorder associated with a variety of respiratory symptoms, including chronic cough and bronchoconstriction [1][2][3][4]. It has been shown to be more frequent in people with asthma [4].…”