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Chronic Cough and Gastroesophageal Reflux Disease: How Do We Establish a Causal Link?Chronic Cough and Gastroesophageal Reflux Disease

Michael F. Vaezi, MD, PhD
Author and Funding Information

From the Center for Swallowing and Esophageal Disorders, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation.

Correspondence to: Michael F. Vaezi, MD, PhD, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 TVC, 1301 22nd Ave S, Nashville, TN 37232-5280; e-mail: Michael.vaezi@vanderbilt.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Vaezi had research grant support from and is on the advisory board of Takeda Pharmaceuticals North America, Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):587-589. doi:10.1378/chest.12-2682
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In this issue of CHEST (see page 605), Kahrilas et al1 report the results of their systematic review of clinical trials reporting cough response to antireflux therapy. They identified nine randomized, controlled studies that treated patients with acid suppression. Eight of the nine trials used proton pump inhibitors (PPIs) (daily or bid for 8-16 weeks); one trial used ranitidine (150 mg daily for 8 weeks). The authors report that there was significant study variability in methodology and measured outcome. Although they could not definitively state that acid-suppression therapy benefits patients with chronic cough, they could not dismiss that possibility. Importantly, they found that the therapeutic gain was in favor of PPI therapy if patients had pathologic esophageal acid exposure (range, 12.5% to 35.8%) than if they had normal esophageal acid exposure (range, 0.0% to 8.6%). The authors conclude that “rigorous patient selection is necessary to identify patient populations likely to be responsive” to acid-suppression therapy.

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