PMID- 16899836
OWN - NLM
STAT- MEDLINE
DCOM- 20060912
LR  - 20140729
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 130
IP  - 2
DP  - 2006 Aug
TI  - Nonacid reflux in patients with chronic cough on acid-suppressive therapy.
PG  - 386-91
AB  - BACKGROUND: It is generally accepted that extraesophageal gastroesophageal reflux 
      disease (GERD) symptoms and their persistence despite acid-suppressive therapy 
      are poor prognostic factors for antireflux surgery. Recent studies indicating 
      that cough can be temporally associated with reflux episodes of pH 4 to 7 (ie, 
      nonacid reflux) reinvigorates the need for a more careful workup in patients with 
      cough suspected to be due to GERD. AIM: To evaluate the frequency of chronic 
      cough associated with nonacid reflux and the response of these patients to 
      laparoscopic Nissen fundoplication. METHODS: We retrospectively reviewed data 
      from patients with persistent cough despite twice-daily proton pump inhibitor 
      (PPI) with or without the use of nighttime regimens of histamine-2 receptor 
      antagonist (H2RA), who had undergone combined multichannel intraluminal impedance 
      and pH monitoring. The association of cough and reflux was evaluated by 
      calculating the symptom index (SI) [positive if > or = 50%]. A subset of patients 
      with positive SI values for impedance-detected reflux with therapy was referred 
      for laparoscopic Nissen fundoplication. RESULTS: Of 50 patients (38 female 
      patients; mean age, 43 years; age range, 6 months to 84 years) who were monitored 
      while receiving therapy, 13 patients (26%) had a positive SI for cough. The 
      SI-positive group had a lower percentage of female patients and patients of 
      younger age compared to the SI-negative group. Laparoscopic Nissen fundoplication 
      was performed in six SI-positive patients who became asymptomatic and stopped 
      receiving acid-suppressive therapy during follow-up evaluations (median time, 17 
      months; range, 12 to 27 months). CONCLUSION: Impedance pH monitoring should be 
      performed while receiving therapy in patients with persistent symptoms who are 
      receiving PPI therapy. A positive SI for nonacid reflux may be helpful in 
      selecting patients who will benefit from antireflux surgery.
FAU - Tutuian, Radu
AU  - Tutuian R
AD  - Division of Gastroenterology/Hepatology, Medical University of South Carolina, 
      Charleston, 29425, USA. tutuianr@musc.edu
FAU - Mainie, Inder
AU  - Mainie I
FAU - Agrawal, Amit
AU  - Agrawal A
FAU - Adams, David
AU  - Adams D
FAU - Castell, Donald O
AU  - Castell DO
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Histamine H2 Antagonists)
RN  - EC 3.6.3.14 (Proton-Translocating ATPases)
SB  - IM
CIN - Chest. 2007 Jul;132(1):358; author reply 358-9. PMID: 17625100
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Chronic Disease
MH  - Cough/*etiology
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Fundoplication
MH  - Gastric Acidity Determination
MH  - Gastroesophageal Reflux/*complications/metabolism/therapy
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Proton-Translocating ATPases/*antagonists & inhibitors
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2006/08/11 09:00
MHDA- 2006/09/13 09:00
CRDT- 2006/08/11 09:00
PHST- 2006/08/11 09:00 [pubmed]
PHST- 2006/09/13 09:00 [medline]
PHST- 2006/08/11 09:00 [entrez]
AID - S0012-3692(15)51852-7 [pii]
AID - 10.1378/chest.130.2.386 [doi]
PST - ppublish
SO  - Chest. 2006 Aug;130(2):386-91. doi: 10.1378/chest.130.2.386.