Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux

Chang, Anne B.; Lasserson, TJ; Kiljander, Toni; Connor, Frances; Gaffney, Justin; Garske, LA

doi:10.1136/bmj.38677.559005.55

Cited by 154 publications

(99 citation statements)

References 22 publications

(49 reference statements)

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“…Além disso, a supressão ácida intensa, tal como é recomendada para a asma, não foi usada em nenhum dos estudos controlados. Contudo, 11 desses estudos usaram IBP como abordagem terapêutica, e as variáveis evolutivas usadas permitiram a inclusão em uma meta-análise 53 . Algum efeito benéfico sobre a tosse pôde ser percebido nos adultos com DRGE.…”

Section: Tosse Crônica Inespecíficaunclassified

Treatment of gastroesophageal reflux disease

Guimarães¹,

Marguet²,

Camargos³

2006

J Pediatr (Rio J)

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Objective: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.Sources: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. Summary of the findings:The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. Conclusions:The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.J Pediatr (Rio J). 2006;82(5 Suppl):S133-45: Gastroesophageal reflux, child, drug therapy, esophagitis, respiratory tract diseases, asthma. ResumoObjetivo: Rever a literatura sobre tratamento da doença do refluxo gastroesofágico (DRGE) com ênfase nos aspectos farmacológi-cos. Identificar particularidades do tratamento farmacológico nas manifestações esofágicas e extra-esofágicas da doença.Fontes de dados: Busca eletrônica na base de dados PubMed/ MEDLINE e Cochrane Collaboration. Procurou-se identificar estudos controlados e randomizados publicados a partir de 2000, bem como revisões que representassem consensos e diretrizes publicados nos últimos 10 anos.Síntese dos dados: Nenhuma das drogas atualmente usadas no tratamento da DRGE altera comprovadamente o mecanismo principal da doença, ou seja, os relaxamentos transitórios do esfíncter esofágico inferior. O tratamento farmacológico da DRGE com sintomas ou com lesões esofágicas é baseado na inibição da secreção ácida, em particular pelos inibidores da bomba de prótons (IBP). Nas situações em que a hiper-reatividade das vias aéreas inferiores coexiste com sintomas esofágicos da DRGE, a inibição da secreção ácida deve...

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Section: Tosse Crônica Inespecíficaunclassified

Treatment of gastroesophageal reflux disease

Guimarães¹,

Marguet²,

Camargos³

2006

J Pediatr (Rio J)

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“…A systematic review found no conclusive support for the use of PPIs in reflux cough [54]. More recently, two randomised controlled trials confirmed little or no effect of PPIs on chronic cough when compared with placebo (placebo, as is common in the trials of cough, having quite a marked effect over baseline) [55,56].…”

Section: Cough and Refluxmentioning

confidence: 99%

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

et al. 2014

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In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions.There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough.The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area. @ERSpublications Cough hypersensitivity syndrome was clearly endorsed by opinion leaders as a valid and useful concept

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“…Nevertheless, 11 of the studies had employed PPI therapy and the variables monitored allowed their inclusion in a meta-analysis. 53 A certain beneficial effect on coughing could be perceived among adults with GERD. The authors concluded that treatment for adults with nonspecific chronic coughing for 2 to 8 weeks could be considered as an empiric treatment test.…”

Section: Nonspecific Chronic Coughingmentioning

confidence: 99%

Tratamento da doença do refluxo gastroesofágico

Guimarães

Marguet

Camargos

2006

J. Pediatr. (Rio J.)

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Objective: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.Sources: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. Summary of the findings:The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. Conclusions:The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.J Pediatr (Rio J). 2006;82(5 Suppl):S133-45: Gastroesophageal reflux, child, drug therapy, esophagitis, respiratory tract diseases, asthma. The symptoms of GERD are less common than the symptoms of GER, but, even so, are very prevalent. A prevalence study reported weekly heartburn sensation and acid regurgitation in approximately 2% of children aged 3 to 9 years and in 5% to 8% of 10 to 17 year-olds. REVIEW ARTICLEHeartburn alone was identified in 17.8% of the children in the older age group. 7 In the Western world, the prevalence of GERD among adults has been estimated from 10% to 20%. 5The refluxate may be exclusively acidic or mixed with duodenum-gastric reflux. Acid reflux is easier to identify and consequently the pathophysiology, diagnosis and treatment are better known. The bile reflux is little understood, but it has been related to severe esophagitis. 8 The case of mixed reflux diagnosis is highly problematic, and is one of the limitations of pH studies. There are no specific clinical trials on mixed reflux in the literature. has not specified the classification by age group, and most of the definitions proposed are applicable to adult patients. Notwithstan...

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Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux

Cited by 154 publications

References 22 publications

Treatment of gastroesophageal reflux disease

Treatment of gastroesophageal reflux disease

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

Tratamento da doença do refluxo gastroesofágico

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