Proton pump inhibitor-responsive chronic cough without acid reflux: a case report

Area of Science:

• Gastroenterology
• Pulmonology
• Pharmacology

Background:

• Diagnosing gastroesophageal reflux disease (GERD)-associated cough traditionally relies on symptom improvement with proton pump inhibitors (PPIs) due to the invasive nature of 24-h esophageal pH monitoring.
• This approach often assumes gastric acid reflux as the sole causative factor.

Purpose of the Study:

• To investigate the efficacy of PPIs in treating chronic cough in patients where gastric acid reflux is not the apparent cause.
• To challenge the conventional diagnostic paradigm for GERD-associated cough.

Main Methods:

• Case presentation of two patients with chronic non-productive cough unresponsive to standard treatments like bronchodilators and glucocorticosteroids.
• Administration of PPIs, observation of cough response, and subsequent discontinuation and re-initiation of PPIs.
• Utilized 24-h esophageal pH monitoring to assess the role of gastric acid reflux.

Main Results:

• Both patients experienced significant cough improvement after switching to PPIs.
• Cough symptoms returned to baseline levels upon PPI discontinuation and resolved again upon re-initiation.
• Esophageal pH monitoring indicated that gastric acid reflux was infrequent in these cases.

Conclusions:

• Proton pump inhibitors may offer therapeutic benefits for chronic cough even in the absence of significant gastric acid reflux.
• This suggests that PPIs might act through mechanisms beyond acid suppression in managing certain types of chronic cough.