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Chronic cough and gastroesophageal reflux
J M Fitzgerald1, C J Allen, M A Craven
1Firestone Regional Chest and Allergy Unit, St. Joseph's Hospital, Hamilton, Ont.
Summary
Gastroesophageal reflux (GER) may cause chronic cough. Medical or surgical antireflux treatment effectively relieved chronic cough in most patients, even without typical GER symptoms.
Area of Science:
- Gastroenterology
- Pulmonology
- Internal Medicine
Background:
- Chronic cough of unknown origin is a common clinical problem.
- Gastroesophageal reflux (GER) is a potential, often overlooked, cause of chronic cough.
- Identifying GER as a cause is crucial for effective treatment.
Purpose of the Study:
- To investigate the role of gastroesophageal reflux (GER) in patients with chronic cough of unknown etiology.
- To evaluate the efficacy of antireflux treatment for chronic cough.
Main Methods:
- Retrospective chart review of 20 patients with chronic cough.
- Assessment of GER symptoms and diagnostic investigations including upper GI radiography, bronchoscopy, and chest X-ray.
- Treatment with medical antireflux therapy for 3 months.
- Further investigation with esophagoscopy, esophageal motility testing, and pH monitoring for non-responders.
- Surgical intervention (fundoplication) for refractory cases.
Main Results:
- Fifteen patients had symptoms suggestive of GER.
- Medical antireflux treatment relieved chronic cough in 14 of 20 patients.
- Five patients required further investigation, with GER confirmed in all.
- Four of these five patients became asymptomatic after fundoplication surgery.
Conclusions:
- Gastroesophageal reflux (GER) should be considered in the differential diagnosis of chronic cough, even in the absence of typical GER symptoms.
- Antireflux therapy, both medical and surgical, is an effective treatment for chronic cough attributed to GER.
- Comprehensive GER investigation is warranted if initial medical treatment fails.