Gastro-Esophageal Reflux and Chronic Cough

Lorcan      McGarvey; S.      Caskey; I.      Mainie

Abstract

Gastro-esophageal reflux disease (GERD) is a highly prevalent disorder which has been implicated in the pathophysiology of chronic cough. However there is much uncertainty as to the precise clinical association between the two. Despite this clinicians frequently consider GERD as an important aggravating factor and often consider trials of antireflux therapy without much evidence base. In this article we aim to summarise the existing literature on definition, epidemiology and clinical presentation of GERD and cough, highlighting current thinking on the pathophysiological and mechanistic association between gut and lung and its relevance to GERD associated cough. In addition we aim to discuss current approaches to the evaluation of patients with suspected reflux cough and how ‘state of the art’ and emerging technologies can more accurately identify such patients and in particular those most likely to benefit from treatment. Finally we provide a review of a number of trials of medical and surgical therapy in GERD associated cough and debate on some of the pertinent issues surrounding efficacy and safety of such treatment.

Keywords: Gastro-esophageal reflux, cough, pathophysiology, antireflux therapy, epidemiology, extraesophageal syndromes, laryngopharyngeal reflux (LPR), laparoscopic techniques, acid regurgitation, proton pump inhibitors, halitosis, dental erosions, chronic hoarseness, supraesophageal, lower esophageal sphincter, Transient Lower Esophageal Sphincter Relaxations, body mass index (BMI), upper esophageal sphincter (UES), lignocaine, ipatropium bromide (anti-cholinergic), tachykinins, tracheal mucociliary transport, Microaspiration, macroaspiration, prokinetic agents, hiatus hernia, multichannel intraluminal impedance, video-fluoroscopy, impedance-pH catheter, antimony pH sensors, symptom sensitivity index (SSI), Symptom Association Probability (SAP), Omeprazole, metoclopramide, cisapride, domperidone, Baclofen, autonomic neuropathy, Arbaclofen placarbil, achlorhydria, pneumonia, clostridium difficile infection (CDI), cystic fibrosis