PULMONARY SYMPTOMS ASSOCIATED WITH GASTROESOPHAGEAL REFLUX - USE OF AMBULATORY PH MONITORING TO DIAGNOSE AND TO DIRECT THERAPY

Background: We studied 54 patients with chronic persistent cough or as thma suspected to be due to reflux using distal and proximal pH monito ring, Therapy for reflux was determined by the referring physician and included H2 blockers (51%), omeprazole (36%), surgery (10%), and life style modifications only (3%), On follow-up evaluation, the effect of anti-reflux therapy on pulmonary symptoms (PS) was scored as excellent , good, fair, no change, or worsening symptoms, Results: Forty-two of the 54 patients (78%) had abnormal reflux, Of these, 28 patients (67%) had abnormal proximal acid exposure, Seventy-one percent of reflux pa tients achieved good to excellent response in PS from antireflux thera py, The response was not significantly different between patients with proximal reflux and those with only distal reflux, None of the patien ts without documented reflux who nevertheless received anti-reflux the rapy had a response, even when fair improvement was included as a resp onse, Seventeen percent of patients whose pulmonary symptoms responded to antireflux therapy would not have been recognized as having abnorm al reflux if proximal pH monitoring had not been done, Conclusions: Th e percentage of patients (78%) with pulmonary symptoms having abnormal reflux is consistent with prior studies, Documenting abnormal gastroe sophageal reflux helps direct appropriate therapy, and proximal pH mon itoring may identify patients with pulmonary symptoms who respond to a ntireflux therapy.