Jp. Waring et al., CHRONIC COUGH AND HOARSENESS IN PATIENTS WITH SEVERE GASTROESOPHAGEALREFLUX DISEASE - DIAGNOSIS AND RESPONSE TO THERAPY, Digestive diseases and sciences, 40(5), 1995, pp. 1093-1097
Gastroesophageal reflux may be responsible for atypical symptoms such
as chronic cough and hoarseness. Our aim was to evaluate and treat pat
ients with severe gastroesophageal reflux and chronic cough or hoarsen
ess with intensive antireflux therapy. Twenty-seven patients with typi
cal heartburn symptoms in addition to significant cough or hoarseness
were treated with aggressive antireflux therapy. We recorded the respo
nse of each symptom to the antireflux therapy. Two patients were lost
to follow-up. Twenty of the 25 (80%) patients showed some improvement
in cough or hoarseness, nine (36%) had no atypical symptoms at follow-
up. The response of heartburn to therapy was strongly predictive of su
ccessful therapy for the atypical symptoms. Cough and hoarseness impro
ved in only two of the five patients with residual heartburn symptoms
compared to 18 of 20 patients with no heartburn (P < 0.04). Only patie
nts with no heartburn symptoms at follow-up had complete resolution of
atypical symptoms. There were no important differences on ambulatory
pH monitoring between partial and complete responders. Improvement in
atypical reflux symptoms, such as chronic cough and hoarseness, is com
mon with aggressive antireflux therapy. There are no findings on ambul
atory esophageal pH monitoring that uniquely identify patients who are
likely to respond to antireflux therapy.