Patients who have chronic cough with no known cause may be more likely to suffer from gastroesophageal reflux disease or GERD, West Penn Allegheny Health System physicians reported in a study published today.

The article, “Antireflux Surgery in Patients with Chronic Cough and Abnormal Proximal Exposure as Measured by Hypopharyngeal Multichannel Intraluminal Impedance” appears in JAMA Surgery.

“These findings could be of great importance to individuals who live with a nagging cough without a known cause,” said Blair A. Jobe, MD, principal investigator of the study and Director of the Institute for the Treatment of Esophageal and Thoracic Disease at West Penn Allegheny Health System.
“Undergoing screening and, if applicable, treatment for GERD can not only improve patients’ quality of life by curbing chronic cough, it can also help prevent serious conditions such as Barrett’s esophagus and esophageal cancer.”

GERD occurs when the muscles at the end of the esophagus fail to properly close, allowing stomach contents to leak back or reflux into the esophagus, causing irritation. Common symptoms of GERD include heartburn, regurgitation, and tasting stomach acid in the back of the throat. Hoarseness, a feeling of having a “lump in your throat” and frequent throat clearing are lesser known symptoms of GERD.

The trial examined 314 patients who underwent testing with a specialized catheter to detect reflux and determined that 49 of them also had chronic cough, a persistent cough with no known cause lasting more than eight weeks. Of the patients with chronic cough, 52 percent were diagnosed with GERD.

“These patients did not display classic symptoms of GERD and may not have been diagnosed with conventional pH testing which measures the amount of stomach acid in the esophagus,” said Toshitaka Hoppo, MD, a general surgeon specializing in esophageal surgery who was involved in the trial.

For such patients, undergoing Hypopharyngeal Multichannel Intraluminal Impedance (HMII) testing is key to achieving a diagnosis. HMII is ideal for assessing the proximity of reflux events from the lower esophageal sphincter muscle regardless of their pH level.

Of the 49 patients with chronic cough in the study, 73 percent were found to have abnormal proximal exposure of reflux. Sixteen of those patients underwent antireflux surgery with 81 percent achieving resolution of their cough.

“Once GERD is diagnosed, many patients may benefit from antireflux surgery,” Dr. Jobe said. “The increased sensitivity of HMII testing enables us to properly diagnose patients who don’t display the telltale signs and symptoms of GERD, treat the underlying problem and prevent future complications while relieving their cough.”

Chronic cough is a condition that affects 8 to 12 percent of adults.

The Institute for the Treatment of Esophageal and Thoracic Disease at WPAHS is a comprehensive, multi-disciplinary program that focuses on the treatment of patients with lung cancer, mediastinal diseases, esophageal cancer, Barrett’s esophagus, hiatal hernia, esophageal motility disorders, gastroesophageal reflux disease, and swallowing issues.

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