Does hiatal hernia impact gastro-oesophageal reflux-related chronic cough?

Abstract

Hiatal hernia (HH) may coexist with gastroesophageal reflux-related chronic cough (GER, CC). The study aimed to evaluate whether the presence of HH was related to CC severity and the response to anti-reflux therapy. This was a retrospective analysis of data on adults with GER-related CC managed in our cough center between 2017 and 2021. Patients who had undergone chest CT and in whom follow up data were available were included. The presence and size of HH were assessed based on thorax CT scanning. Patients were treated with modification of diet and proton pump inhibitors. The response to treatment was assessed by the change in quality of life (QOL) measured by Leicester Cough Questionnaire (LCQ) and cough severity was measured by 100 mm Visual Analogue Scale (VAS). Forty five adults (28 F, 17 M) were included. HH was demonstrated in 12 patients (26.6%). Patients with HH did not differ from those without HH in clinical characteristics, cough duration and severity, and cough-related QOL. We found moderate positive correlations between maximal sagittal diameter of HH and cough severity (rho=0.692, p=0.013) and duration (rho=0.720, p=0.008). Patients without HH responded better to anti-reflux therapy with significant LCQ improvement. A strong negative correlation between sagittal diameter of HH gate and increase in LCQ (rho=-0.764, p=0.004) was demonstrated. The presence of HH identified in chest CT may impact cough severity, duration and response to anti-reflux treatment in patients with GER-related CC. Further prospective studies are justified to confirm significance of HH in the management of CC.