Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 2003 Aug;58(8):699–702. doi: 10.1136/thorax.58.8.699

Abnormal oesophageal motility in patients with chronic cough

J Kastelik 1, A Redington 1, I Aziz 1, G Buckton 1, C Smith 1, M Dakkak 1, A Morice 1
PMCID: PMC1746758  PMID: 12885989

Abstract

Methods: Oesophageal manometry and 24 hour pH monitoring were performed in 43 patients with chronic cough, 34 of whom had symptoms suggestive of gastro-oesophageal reflux. Comparative manometric measurements were made in 21 healthy subjects.

Results: Nine patients with chronic cough had normal manometry and 24 hour pH. Of the remaining 34 patients, 11 (32%) had abnormal manometry alone, five (15%) had abnormal 24 hour pH monitoring alone, and in 18 (53%) both tests were abnormal. Only one patient in the control group had manometric abnormalities.

Conclusions: These results point to a previously unrecognised high prevalence of abnormal oesophageal manometry in patients presenting with chronic cough. Oesophageal dysmotility may therefore be important in the pathogenesis of cough in these patients.

Full Text

The Full Text of this article is available as a PDF (113.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brightling C. E., Ward R., Goh K. L., Wardlaw A. J., Pavord I. D. Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med. 1999 Aug;160(2):406–410. doi: 10.1164/ajrccm.160.2.9810100. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Fitzgerald J. M., Allen C. J., Craven M. A., Newhouse M. T. Chronic cough and gastroesophageal reflux. CMAJ. 1989 Mar 1;140(5):520–524. [PMC free article] [PubMed] [Google Scholar]
  4. Fouad Y. M., Katz P. O., Hatlebakk J. G., Castell D. O. Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms. Am J Gastroenterol. 1999 Jun;94(6):1464–1467. doi: 10.1111/j.1572-0241.1999.1127_e.x. [DOI] [PubMed] [Google Scholar]
  5. French C. L., Irwin R. S., Curley F. J., Krikorian C. J. Impact of chronic cough on quality of life. Arch Intern Med. 1998 Aug 10;158(15):1657–1661. doi: 10.1001/archinte.158.15.1657. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. Ing A. J., Ngu M. C., Breslin A. B. Chronic persistent cough and gastro-oesophageal reflux. Thorax. 1991 Jul;46(7):479–483. doi: 10.1136/thx.46.7.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. 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]
  10. 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]
  11. 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]
  12. 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]
  13. 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]
  14. Kahrilas P. J., Dodds W. J., Hogan W. J., Kern M., Arndorfer R. C., Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986 Oct;91(4):897–904. doi: 10.1016/0016-5085(86)90692-x. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. 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]
  17. Leite L. P., Johnston B. T., Barrett J., Castell J. A., Castell D. O. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997 Sep;42(9):1859–1865. doi: 10.1023/a:1018802908358. [DOI] [PubMed] [Google Scholar]
  18. Marchesani F., Cecarini L., Pela R., Sanguinetti C. M. Causes of chronic persistent cough in adult patients: the results of a systematic management protocol. Monaldi Arch Chest Dis. 1998 Oct;53(5):510–514. [PubMed] [Google Scholar]
  19. 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]
  20. 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]
  21. O'Connell F., Thomas V. E., Pride N. B., Fuller R. W. Capsaicin cough sensitivity decreases with successful treatment of chronic cough. Am J Respir Crit Care Med. 1994 Aug;150(2):374–380. doi: 10.1164/ajrccm.150.2.8049818. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. Palombini B. C., Villanova C. A., Araújo E., Gastal O. L., Alt D. C., Stolz D. P., Palombini C. O. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest. 1999 Aug;116(2):279–284. doi: 10.1378/chest.116.2.279. [DOI] [PubMed] [Google Scholar]
  24. Patti M. G., Debas H. T., Pellegrini C. A. Esophageal manometry and 24-hour pH monitoring in the diagnosis of pulmonary aspiration secondary to gastroesophageal reflux. Am J Surg. 1992 Apr;163(4):401–406. doi: 10.1016/0002-9610(92)90041-o. [DOI] [PubMed] [Google Scholar]
  25. Poe R. H., Harder R. V., Israel R. H., Kallay M. C. Chronic persistent cough. Experience in diagnosis and outcome using an anatomic diagnostic protocol. Chest. 1989 Apr;95(4):723–728. doi: 10.1378/chest.95.4.723. [DOI] [PubMed] [Google Scholar]
  26. Poe R. H., Israel R. H., Utell M. J., Hall W. J. Chronic cough: bronchoscopy or pulmonary function testing? Am Rev Respir Dis. 1982 Jul;126(1):160–162. doi: 10.1164/arrd.1982.126.1.160. [DOI] [PubMed] [Google Scholar]
  27. Puolijoki H., Lahdensuo A. Causes of prolonged cough in patients referred to a chest clinic. Ann Med. 1989 Dec;21(6):425–427. doi: 10.3109/07853898909149233. [DOI] [PubMed] [Google Scholar]
  28. Richter J. E., Wu W. C., Johns D. N., Blackwell J. N., Nelson J. L., 3rd, Castell J. A., Castell D. O. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of "abnormal" contractions. Dig Dis Sci. 1987 Jun;32(6):583–592. doi: 10.1007/BF01296157. [DOI] [PubMed] [Google Scholar]
  29. 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]
  30. Simpson G. Investigation and management of persistent dry cough. Thorax. 1999 May;54(5):469–470. doi: 10.1136/thx.54.5.468b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. 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]
  32. 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]
  33. Waring J. P., Lacayo L., Hunter J., Katz E., Suwak B. Chronic cough and hoarseness in patients with severe gastroesophageal reflux disease. Diagnosis and response to therapy. Dig Dis Sci. 1995 May;40(5):1093–1097. doi: 10.1007/BF02064205. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES