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Clinical outcomes of gastroesophageal reflux disease-related chronic cough following antireflux fundoplication

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Abstract

Background

Despite the effectiveness of antireflux fundoplication for typical gastroesophageal reflux disease, outcomes regarding surgical therapy for patients with gastroesophageal reflux disease-related chronic cough are currently unclear. The purpose of this study was to evaluate whether antireflux surgery for patients with chronic cough is effective, and to assess the correlation between indexes, such as symptom index and symptom association probability, and response to surgery.

Methods

We performed a retrospective review of a prospectively collected database from a 3-site institution from 2013 to 2017. Of 1149 patients who underwent antireflux surgery, 41 presented with chronic cough as a main symptom related to gastroesophageal reflux disease. Preoperatively, patients underwent a symptom assessment, esophagogastroduodenoscopy, esophageal 24-h pH monitoring, and manometry. Patients were followed up at 6 weeks and 12 months post-surgery.

Results

Thirty-three (80.5%) patients underwent Nissen fundoplication, while 8 (19.5%) underwent Toupet fundoplication. Isolated chronic cough was present in 8 (19.5%) patients, and median (range) DeMeester score was 28.9 (0.3–96.7). After 12-month follow-up, chronic cough was absent in 28 (68.3%) patients (P = .02). Typical reflux symptoms responded well to surgery, but response was not optimal. Postoperative dysphagia and atypical reflux symptoms were slightly worse on long-term follow-up; however, differences were not significant (P ≥ .2). When examining how the different symptom indexes correlated with complete, partial, or no response in patients with gastroesophageal reflux disease-related cough, there was no notable agreement on predicted response to surgery.

Conclusions

Antireflux surgery, although less predictable, is effective for the treatment of gastroesophageal reflux disease-related chronic cough.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. Division of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Tamara Díaz Vico & Enrique F. Elli

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  1. Tamara Díaz Vico
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  2. Enrique F. Elli
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Correspondence to Tamara Díaz Vico.

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Díaz Vico, T., Elli, E.F. Clinical outcomes of gastroesophageal reflux disease-related chronic cough following antireflux fundoplication. Esophagus 17, 92–98 (2020). https://doi.org/10.1007/s10388-019-00701-z

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