Chronic Cough Due to Gastroesophageal Reflux in Adults

Abstract

The panelists (1) endorsed the use of a diagnostic/therapeutic algorithm addressing causes of common cough, including symptomatic reflux; (2) advised that although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, PPIs demonstrated no benefit when used in isolation; and (3) suggested that physiological testing be reserved for refractory patients being considered for antireflux surgery or for those in whom there is strong clinical suspicion warranting diagnostic testing.

Determinants of reflux-induced chronic cough

“…This suggests that the time that the refluxate is present in the oesophagus is more important than the time that acid is present and therefore the quantity of the refluxate, or a non-acidic component of the refluxate, could be an important factor. These observations may help to explain the limited efficacy of acid-inhibitory medication in placebo-controlled trials,1 25 and support the notion that refluxate sensitises the oesophagus to subsequent reflux episodes. It should be borne in mind that clearance starts with a peristaltic contraction which removes most of the reflux volume.…”

“…Moreover, it is unclear why some patients with GOR also present with chronic cough while others do not, and why acid-suppressive therapy was found to be ineffective in reducing the cough frequency in many placebo-controlled trials 1 25. This is the first study in which a wide range of reflux characteristics were evaluated in patients in whom a temporal relationship between reflux and cough events was found.…”

Current and future perspectives in the management of gastroesophageal reflux disease

“…According to international recommendations, in patients with chronic cough suspected to be due to reflux‐cough syndrome, it is recommended that treatment should include diet modification to promote weight loss in overweight or obese patients, head of bed evaluation, and avoiding late meals within 3 h of bedtime. In patients who report heartburn or regurgitation, PPIs, H2‐receptor antagonists, alginate, or antacid therapy are sufficient to control these symptoms.…”

Medical Therapy of Gastroesophageal Reflux Disease Beyond Proton Pump Inhibitors: Where Are We Heading

“…If acidic reflux still remains, compliance should be critically evaluated as well as appropriate administration of the PPI. If acidic reflux is excluded, the therapeutic options are much more narrow: In these cases, no effective medical therapy is available, and a purely surgical approach is not recommended based on current experience [40] since no high-quality studies, particularly randomized trials, have been published so far [41]. It is not surprising that patients reporting concomitant typical reflux symptoms are more likely to benefit from antireflux surgery compared to those in whom typical GERD symptoms are lacking [42], placing a question mark over the surgical option ( fig.…”

“…Primarily, PPI therapy should not be considered [40] or discontinued if started previously. From the present experience, neuromodulators (e.g., amitriptyline, imipramine, gabapentin) should be considered in this setting; treatment using these drugs will not be effective in all cases, and some patients may not tolerate the therapy due to side effects (especially tricyclics).…”