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Clinical Investigations: COUGH |

Chronic Cough due to Gastroesophageal Reflux Disease*: Failure to Resolve Despite Total/Near-Total Elimination of Esophageal Acid

Richard S. Irwin, MD, FCCP; John K. Zawacki, MD; Mark M. Wilson, MD; Cynthia T. French, MSN; Mark P. Callery, MD
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*From the Departments of Medicine (Drs. Irwin, Zawacki, Wilson, and French) and Surgery (Dr. Callery), University of Massachusetts Medical School, Worcester, MA.

Correspondence to: Richard S. Irwin, MD, FCCP, U Mass Memorial Medical Center, University Campus, Division of Pulmonary, Allergy, and Critical Care Medicine, 55 Lake Ave North, Worcester, MA 01655; e-mail address: irwinr@ummhc.org



Chest. 2002;121(4):1132-1140. doi:10.1378/chest.121.4.1132
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Background: While medical therapy may fail to improve cough due to gastroesophageal reflux disease (GERD), it is not known if inadequate esophageal acid suppression is responsible.

Methods: In a prospective, before-and-after interventional trial, we assessed the effects of antireflux surgery in eight patients whose chronic coughs were due to GERD resistant to intensive medical therapy. All patients met a profile predicting that cough was likely due to GERD and had an initial positive 24-h esophageal pH monitoring study, and then underwent serial 24-h esophageal pH monitoring on gradually intensified medical therapy until the percentage of time that esophageal pH was < 4 was zero and there were no acid reflux events > 4 min. The effects of medical and surgical therapy on cough were assessed clinically by a visual analog scale (VAS) and the Adverse Cough Outcome Survey (ACOS).

Results: Before surgery (median, 23.7 days), patients still complained of cough, VAS score was 73.1 ± 6.1, and ACOS score was 15.0 ± 1.1. After surgery (median, 41.2 days and 1 year), cough improved in all, VAS score decreased to 19.1 ± 8.3 and 22.6 ± 8.1 (p = 0.001), respectively, and ACOS score decreased to 2.0 ± 1.3 and 3.6 ± 2.3, respectively (p = 0.002).

Conclusions: Antireflux surgery can improve chronic cough due to GERD resistant to intensive medical therapy. There is a clinical profile that can predict when GERD is the likely cause of cough. GERD cannot be excluded on clinical grounds as the potential cause of cough. The term acid reflux disease, when applied to chronic cough due to GERD, can be a misnomer.

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