Related Experiment Video
Updated: Jun 7, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined
K Blondeau1, V Mertens, L Dupont
1Center for Gastroenterological Research, K.U.Leuven, Leuven, Belgium.
Insights
Gastroesophageal reflux (GER), both acid and weakly acidic, can trigger chronic cough in children. Objective cough measurement improves analysis, showing cough does not induce GER.
Area of Science:
- Pediatric Gastroenterology
- Respiratory Medicine
- Diagnostic Technology
Background:
- Assessing the link between reflux and chronic cough in children is difficult.
- Esophageal impedance-pH monitoring is sensitive for reflux detection.
- Event marker-based cough recording may lack precision.
Purpose of the Study:
- To investigate the precise temporal relationship between reflux and cough in pediatric chronic cough.
- To evaluate the accuracy of objective cough detection versus event markers in symptom association analysis.
Main Methods:
- Ambulatory impedance-pH-manometry was used in 26 children with chronic cough.
- Manometry provided precise cough recognition.
- Reflux was classified (acid, weakly acidic, weakly alkaline), and symptom association probability (SAP) was calculated.
Main Results:
- Reflux preceded cough in 22/26 patients.
- Positive SAP for reflux-cough was observed in 10 patients, mostly with normal acid exposure.
- Objective cough recording identified more reflux-cough associations than event markers.
Conclusions:
- Both acid and weakly acidic GER can precede cough in children.
- Cough does not appear to induce GER.
- Objective cough recording enhances the analysis of reflux-cough association.
Introduction:
Assessment of the reflux-cough association in children is challenging. Esophageal (impedance) pH recording is sensitive to recognize reflux. However, cough recorded by an event marker, possibly lacks accuracy. We aimed to study the exact time relationship between reflux and cough in children with chronic cough.
Methods:
Twenty-six children (12 boys; 1-10.5 years) with chronic unexplained cough underwent ambulatory impedance-pH-manometry recordings. Manometry was used for precise cough recognition. Reflux was assessed with impedance-pH monitoring and defined as acid (pH <4), weakly acidic (WA) (pH 4-7), weakly alkaline (WALK) (pH ≥7), or acid only (pH <4 for ≥4 sec without impedance pattern). Cough was considered "induced by" reflux, if it started ≤2 min after reflux. The Symptom Association Probability (SAP) was calculated and considered positive if >95%. Cough-induced reflux if it occurred 30 sec before the reflux event.
Results:
Impedance-pH detected 30 (21-52) reflux episodes/patient (55.2% acid, 41.5% WA, and 3.3% WALK). Additionally 59 acid only events were identified [1 (0-21)/patient]. Manometry detected 47 (5-203) cough bursts/patient. Reflux-cough was found in 22/26 patients. Ten patients had a +SAP for reflux-cough (one acid, six WA, and three acid + WA gastroesophageal reflux [GER]), of which nine had a normal acid exposure. Six out of 10 patients with +SAP using manometry had a +SAP using the event marker. Cough-reflux was detected in 19 patients [3 (0-7)/patient]. Only a small fraction of the esophageal acid exposure [9.6 (0.4-31.8%)] was secondary to cough.
Conclusion:
Both acid and WA GER may precede cough in children with unexplained cough, but cough does not induce GER. Objective cough recording improves symptom association analysis.
Related Concept Videos
01:25Gastroesophageal Reflux Disease
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:29Gastroesophageal Reflux Disease I: Meaning and Pathophysiology
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:27Esophageal Achalasia
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...