The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes

Smith, Jaclyn A.; Houghton, Lesley A.

doi:10.1186/1745-9974-9-12

Cited by 49 publications

(45 citation statements)

References 78 publications

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“…Dysfunction of the upper esophageal sphincter and insufficiency of protective laryngeal and pharyngeal reflexes may predispose patients to microaspiration. 23 Simultaneous esophageal and tracheal pH drops during reflux episodes in asthma patients supports this hypothesis. 13 The presence of pepsin, bile acids or LLMs in BAL specimens has been proposed as an index to establish the degree of gastric aspiration.…”

Section: Discussionsupporting

confidence: 63%

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

Özdemir

Erdinç

Vardar

et al. 2017

J Neurogastroenterol Motil

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Background/AimsGastroesophageal reflux disease (GERD) is one of the main causes of chronic cough. We evaluated the role of microaspiration in the pathogenesis of reflux-related cough by determining the amount of lipid-laden macrophages (LLMs) in bronchoalveolar lavage (BAL) specimens. MethodsA total of 161 cases of chronic cough were evaluated, and 36 patients (average age 48.2 years) were recruited for this single center prospective study. Patients with a history of smoking, angiotensin converting enzyme inhibitor usage, any abnormality on pulmonary function tests, abnormal chest X-rays, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. BAL specimens for LLM determination were obtained from 34 patients by flexible bronchoscopy. ResultsPatients with pathological intra-esophageal reflux according to multichannel intraluminal impedance and pH monitoring had higher LLM positivity in BAL specimens than patients without pathological reflux (8/14 in reflux positive group vs 1/22 in reflux negative group; P = 0.004). The BAL cell distribution was not different between the 2 groups (P = 0.574 for macrophages, P = 0.348 for lymphocytes, P = 0.873 for neutrophils and P = 0.450 for eosinophils). ConclusionsOur results confirm the role of the microaspiration of refluxate in the pathogenetic mechanism of chronic cough. While bronchoscopy is indicated in patients with chronic cough, in addition to the routine airway evaluation, BAL and LLM detection should be performed. LLM can be used to diagnose aspiration in reflux-related chronic cough. Future studies are needed to evaluate the response to antireflux medications or surgery in patients with LLM positivity.

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Section: Discussionsupporting

confidence: 63%

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

Özdemir

Erdinç

Vardar

et al. 2017

J Neurogastroenterol Motil

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“…Opinions about the appearance of the vocal cords are often crucial information to allergists and pulmonologists. 8 …”

Section: Is Gerd Involved?mentioning

confidence: 97%

Considerations in difficult‐to‐control asthma

Lanier

Tierce

2015

Int Forum Allergy Rhinol

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“…Cough hypersensitivity at the oesophageal level has been proposed to result from the neural crosstalk between the oesophagus and airway that connects gastro-oesophageal reflux events and cough triggers. There is little evidence for this perhaps because of our current inability to accurately detect laryngo-pharyngeal refluxate (52). Tests of oesophageal sensitivity are required.…”

Section: Idiopathic Cough and Cough Associated With Respiratory Condimentioning

confidence: 99%

Advances in mechanisms and management of chronic cough: The Ninth London International Cough Symposium 2016

Chung

2017

Pulmonary Pharmacology & Therapeutics

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At the Ninth London International Cough Symposium held in June 2016, advances in chronic cough were presented. Chronic cough has been labelled as a cough hypersensitivity syndrome (CHS) with neuroinflammatory mechanisms likely to be the underlying mechanisms. The concept is that there is a stage of peripheral sensitisation induced by inflammatory factors setting up the scene for a central component that can be visualised by functional magnetic resonance imaging. There has also been progress in assessing CHS patients in the clinic in terms of measuring cough, with an increasing interest in assessing different types of cough associated with respiratory diseases such as asthma, COPD, bronchiectasis and pulmonary fibrosis. There is an emerging area of new antitussives in the form of neuromodulators. These advances have been paralleled by improvements in the management of patients with chronic cough. However, more work is needed but the future looks promising. To view all the submission files, including those not included in the PDF, click on the manuscript title on your EVISE Homepage, then click 'Download zip file'. Keywords

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The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes

Cited by 49 publications

References 78 publications

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

Considerations in difficult‐to‐control asthma

Advances in mechanisms and management of chronic cough: The Ninth London International Cough Symposium 2016

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