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. 2003 Dec;58(12):1092–1095. doi: 10.1136/thorax.58.12.1092

Cough · 3: Chronic cough and gastro-oesophageal reflux

G Fontana 1, M Pistolesi 1
PMCID: PMC1746530  PMID: 14645983

Abstract

The pathogenesis and clinical features of gastro-oesophageal reflux related cough are complex and the diagnostic tests available are of limited reliability. Treatment needs to be tailored to the specific needs of individual patients and other possible causes of chronic cough should be investigated. Treatment should only be considered to have failed when cough persists after administration of proton pump inhibitors at an adequate dosage for a sufficient length of time.

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Selected References

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  1. Allen C. J., Anvari M. Gastro-oesophageal reflux related cough and its response to laparoscopic fundoplication. Thorax. 1998 Nov;53(11):963–968. doi: 10.1136/thx.53.11.963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Avidan B., Sonnenberg A., Schnell T. G., Sontag S. J. Temporal associations between coughing or wheezing and acid reflux in asthmatics. Gut. 2001 Dec;49(6):767–772. doi: 10.1136/gut.49.6.767. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BERNSTEIN L. M., BAKER L. A. A clinical test for esophagitis. Gastroenterology. 1958 May;34(5):760–781. [PubMed] [Google Scholar]
  4. Bolser D. C., DeGennaro F. C., O'Reilly S., Chapman R. W., Kreutner W., Egan R. W., Hey J. A. Peripheral and central sites of action of GABA-B agonists to inhibit the cough reflex in the cat and guinea pig. Br J Pharmacol. 1994 Dec;113(4):1344–1348. doi: 10.1111/j.1476-5381.1994.tb17145.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. DeMeester T. R., Bonavina L., Iascone C., Courtney J. V., Skinner D. B. Chronic respiratory symptoms and occult gastroesophageal reflux. A prospective clinical study and results of surgical therapy. Ann Surg. 1990 Mar;211(3):337–345. doi: 10.1097/00000658-199003000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. DeVault K. R. Overview of therapy for the extraesophageal manifestations of gastroesophageal reflux disease. Am J Gastroenterol. 2000 Aug;95(8 Suppl):S39–S44. doi: 10.1016/s0002-9270(00)01077-7. [DOI] [PubMed] [Google Scholar]
  7. Dennish G. W., Castell D. O. Inhibitory effect of smoking on the lower esophageal sphincter. N Engl J Med. 1971 May 20;284(20):1136–1137. doi: 10.1056/NEJM197105202842007. [DOI] [PubMed] [Google Scholar]
  8. Drolet B., Rousseau G., Daleau P., Cardinal R., Turgeon J. Domperidone should not be considered a no-risk alternative to cisapride in the treatment of gastrointestinal motility disorders. Circulation. 2000 Oct 17;102(16):1883–1885. doi: 10.1161/01.cir.102.16.1883. [DOI] [PubMed] [Google Scholar]
  9. Eubanks T. R., Omelanczuk P. E., Maronian N., Hillel A., Pope C. E., 2nd, Pellegrini C. A. Pharyngeal pH monitoring in 222 patients with suspected laryngeal reflux. J Gastrointest Surg. 2001 Mar-Apr;5(2):183–191. doi: 10.1016/s1091-255x(01)80032-9. [DOI] [PubMed] [Google Scholar]
  10. Eubanks T. R., Omelanczuk P., Hillel A., Maronian N., Pope C. E., Pellegrini C. A. Pharyngeal pH measurements in patients with respiratory symptoms before and during proton pump inhibitor therapy. Am J Surg. 2001 May;181(5):466–470. doi: 10.1016/s0002-9610(01)00597-9. [DOI] [PubMed] [Google Scholar]
  11. Fibbe C., Layer P., Keller J., Strate U., Emmermann A., Zornig C. Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology. 2001 Jul;121(1):5–14. doi: 10.1053/gast.2001.25486. [DOI] [PubMed] [Google Scholar]
  12. German V. F., Corrales R., Ueki I. F., Nadel J. A. Reflex stimulation of tracheal mucus gland secretion by gastric irritation in cats. J Appl Physiol Respir Environ Exerc Physiol. 1982 May;52(5):1153–1155. doi: 10.1152/jappl.1982.52.5.1153. [DOI] [PubMed] [Google Scholar]
  13. Holloway R. H., Lyrenas E., Ireland A., Dent J. Effect of intraduodenal fat on lower oesophageal sphincter function and gastro-oesophageal reflux. Gut. 1997 Apr;40(4):449–453. doi: 10.1136/gut.40.4.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ing A. J., Ngu M. C., Breslin A. B. Chronic persistent cough and clearance of esophageal acid. Chest. 1992 Dec;102(6):1668–1671. doi: 10.1378/chest.102.6.1668. [DOI] [PubMed] [Google Scholar]
  15. Ing A. J., Ngu M. C., Breslin A. B. Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. Am J Respir Crit Care Med. 1994 Jan;149(1):160–167. doi: 10.1164/ajrccm.149.1.8111576. [DOI] [PubMed] [Google Scholar]
  16. Ing A. J., Ngu M. C. Cough and gastro-oesophageal reflux. Lancet. 1999 Mar 20;353(9157):944–946. doi: 10.1016/S0140-6736(98)00354-7. [DOI] [PubMed] [Google Scholar]
  17. Irwin R. S., Corrao W. M., Pratter M. R. Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis. 1981 Apr;123(4 Pt 1):413–417. doi: 10.1164/arrd.1981.123.4.413. [DOI] [PubMed] [Google Scholar]
  18. Irwin R. S., Curley F. J., French C. L. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis. 1990 Mar;141(3):640–647. doi: 10.1164/ajrccm/141.3.640. [DOI] [PubMed] [Google Scholar]
  19. Irwin R. S., French C. L., Curley F. J., Zawacki J. K., Bennett F. M. Chronic cough due to gastroesophageal reflux. Clinical, diagnostic, and pathogenetic aspects. Chest. 1993 Nov;104(5):1511–1517. doi: 10.1378/chest.104.5.1511. [DOI] [PubMed] [Google Scholar]
  20. Irwin R. S., Zawacki J. K., Curley F. J., French C. L., Hoffman P. J. Chronic cough as the sole presenting manifestation of gastroesophageal reflux. Am Rev Respir Dis. 1989 Nov;140(5):1294–1300. doi: 10.1164/ajrccm/140.5.1294. [DOI] [PubMed] [Google Scholar]
  21. Irwin Richard S., Madison J. Mark. The persistently troublesome cough. Am J Respir Crit Care Med. 2002 Jun 1;165(11):1469–1474. doi: 10.1164/rccm.2110097. [DOI] [PubMed] [Google Scholar]
  22. Irwin Richard S., Zawacki John K., Wilson Mark M., French Cynthia T., Callery Mark P. Chronic cough due to gastroesophageal reflux disease: failure to resolve despite total/near-total elimination of esophageal acid. Chest. 2002 Apr;121(4):1132–1140. doi: 10.1378/chest.121.4.1132. [DOI] [PubMed] [Google Scholar]
  23. Johnson W. E., Hagen J. A., DeMeester T. R., Kauer W. K., Ritter M. P., Peters J. H., Bremner C. G. Outcome of respiratory symptoms after antireflux surgery on patients with gastroesophageal reflux disease. Arch Surg. 1996 May;131(5):489–492. doi: 10.1001/archsurg.1996.01430170035005. [DOI] [PubMed] [Google Scholar]
  24. Johnston B. T., McFarland R. J., Collins J. S., Love A. H. Symptom index as a marker of gastro-oesophageal reflux disease. Br J Surg. 1992 Oct;79(10):1054–1055. doi: 10.1002/bjs.1800791022. [DOI] [PubMed] [Google Scholar]
  25. Kahrilas P. J., Clouse R. E., Hogan W. J. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology. 1994 Dec;107(6):1865–1884. doi: 10.1016/0016-5085(94)90835-4. [DOI] [PubMed] [Google Scholar]
  26. Kiljander T. O., Salomaa E. R., Hietanen E. K., Terho E. O. Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole. Eur Respir J. 2000 Oct;16(4):633–638. doi: 10.1034/j.1399-3003.2000.16d11.x. [DOI] [PubMed] [Google Scholar]
  27. Knight R. E., Wells J. R., Parrish R. S. Esophageal dysmotility as an important co-factor in extraesophageal manifestations of gastroesophageal reflux. Laryngoscope. 2000 Sep;110(9):1462–1466. doi: 10.1097/00005537-200009000-00010. [DOI] [PubMed] [Google Scholar]
  28. Leite L. P., Johnston B. T., Just R. J., Castell D. O. Persistent acid secretion during omeprazole therapy: a study of gastric acid profiles in patients demonstrating failure of omeprazole therapy. Am J Gastroenterol. 1996 Aug;91(8):1527–1531. [PubMed] [Google Scholar]
  29. McGarvey L. P., Heaney L. G., Lawson J. T., Johnston B. T., Scally C. M., Ennis M., Shepherd D. R., MacMahon J. Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax. 1998 Sep;53(9):738–743. doi: 10.1136/thx.53.9.738. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Mello C. J., Irwin R. S., Curley F. J. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med. 1996 May 13;156(9):997–1003. [PubMed] [Google Scholar]
  31. Nebel O. T., Fornes M. F., Castell D. O. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov;21(11):953–956. doi: 10.1007/BF01071906. [DOI] [PubMed] [Google Scholar]
  32. Ours T. M., Kavuru M. S., Schilz R. J., Richter J. E. A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Am J Gastroenterol. 1999 Nov;94(11):3131–3138. doi: 10.1111/j.1572-0241.1999.01504.x. [DOI] [PubMed] [Google Scholar]
  33. Pehl C., Waizenhoefer A., Wendl B., Schmidt T., Schepp W., Pfeiffer A. Effect of low and high fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects. Am J Gastroenterol. 1999 May;94(5):1192–1196. doi: 10.1111/j.1572-0241.1999.01064.x. [DOI] [PubMed] [Google Scholar]
  34. Richter J. E., Castell D. O. Gastroesophageal reflux. Pathogenesis, diagnosis, and therapy. Ann Intern Med. 1982 Jul;97(1):93–103. doi: 10.7326/0003-4819-97-1-93. [DOI] [PubMed] [Google Scholar]
  35. Ruzkowski C. J., Sanowski R. A., Austin J., Rohwedder J. J., Waring J. P. The effects of inhaled albuterol and oral theophylline on gastroesophageal reflux in patients with gastroesophageal reflux disease and obstructive lung disease. Arch Intern Med. 1992 Apr;152(4):783–785. [PubMed] [Google Scholar]
  36. Schindlbeck N. E., Heinrich C., Huber R. M., Müller-Lissner S. A. Effects of albuterol (salbutamol) on esophageal motility and gastroesophageal reflux in healthy volunteers. JAMA. 1988 Dec 2;260(21):3156–3158. [PubMed] [Google Scholar]
  37. Sekizawa S., Ishikawa T., Sant'Ambrogio F. B., Sant'Ambrogio G. Vagal esophageal receptors in anesthetized dogs: mechanical and chemical responsiveness. J Appl Physiol (1985) 1999 Apr;86(4):1231–1235. doi: 10.1152/jappl.1999.86.4.1231. [DOI] [PubMed] [Google Scholar]
  38. Sifrim D., Holloway R., Silny J., Xin Z., Tack J., Lerut A., Janssens J. Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology. 2001 Jun;120(7):1588–1598. doi: 10.1053/gast.2001.24841. [DOI] [PubMed] [Google Scholar]
  39. Smyrnios N. A., Irwin R. S., Curley F. J. Chronic cough with a history of excessive sputum production. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Chest. 1995 Oct;108(4):991–997. doi: 10.1378/chest.108.4.991. [DOI] [PubMed] [Google Scholar]
  40. Sullivan C. E., Kozar L. F., Murphy E., Phillipson E. A. Arousal, ventilatory, and airway responses to bronchopulmonary stimulation in sleeping dogs. J Appl Physiol Respir Environ Exerc Physiol. 1979 Jul;47(1):17–25. doi: 10.1152/jappl.1979.47.1.17. [DOI] [PubMed] [Google Scholar]
  41. Tomonaga Tetsuya, Awad Ziad T., Filipi Charles J., Hinder Ronald A., Selima Mohamed, Tercero Francisco, Jr, Marsh Robert E., Shiino Yutaka, Welch Rebecca. Symptom predictability of reflux-induced respiratory disease. Dig Dis Sci. 2002 Jan;47(1):9–14. doi: 10.1023/a:1013290715062. [DOI] [PubMed] [Google Scholar]
  42. Vela M. F., Camacho-Lobato L., Srinivasan R., Tutuian R., Katz P. O., Castell D. O. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001 Jun;120(7):1599–1606. doi: 10.1053/gast.2001.24840. [DOI] [PubMed] [Google Scholar]
  43. Vitale G. C., Cheadle W. G., Patel B., Sadek S. A., Michel M. E., Cuschieri A. The effect of alcohol on nocturnal gastroesophageal reflux. JAMA. 1987 Oct 16;258(15):2077–2079. [PubMed] [Google Scholar]
  44. Winters C., Jr, Spurling T. J., Chobanian S. J., Curtis D. J., Esposito R. L., Hacker J. F., 3rd, Johnson D. A., Cruess D. F., Cotelingam J. D., Gurney M. S. Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology. 1987 Jan;92(1):118–124. [PubMed] [Google Scholar]
  45. Wynne J. The clinical meaning of the third heart sound. Am J Med. 2001 Aug;111(2):157–158. doi: 10.1016/s0002-9343(01)00809-9. [DOI] [PubMed] [Google Scholar]
  46. Wysowski D. K., Corken A., Gallo-Torres H., Talarico L., Rodriguez E. M. Postmarketing reports of QT prolongation and ventricular arrhythmia in association with cisapride and Food and Drug Administration regulatory actions. Am J Gastroenterol. 2001 Jun;96(6):1698–1703. doi: 10.1111/j.1572-0241.2001.03927.x. [DOI] [PubMed] [Google Scholar]

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