Surgical Endoscopy

, Volume 16, Issue 4, pp 567–571 | Cite as

Chronic cough due to gastroesophageal reflux disease

Efficacy of antireflux surgery
  • Y. W. Novitsky
  • J. K. Zawacki
  • R. S. Irwin
  • C. T. French
  • V. M. Hussey
  • M. P. Callery
Original Articles

Abstract

Background

Gastroesophageal reflux disease (GERD) can be overlooked as the cause of chronic cough (CC) when typical gastrointestinal symptoms are absent or minimal. We analyzed the outcomes of Nissen fundoplication (NF) for patients who failed medical therapy for CC attributable only to GERD (G-CC). We performed a prospective outcome evaluation of 21 consecutive patients with G-CC undergoing NF from 1997 to 2000 at a tertiary care university hospital.

Materials and Methods

Twenty-one patients without prior antireflux surgeries had G-CC diagnosed by a clinical profile and 24-h pH monitoring showing a cough-reflux correlation. Respiratory symptoms alone were present in 53% of patients. NF was performed when G-CC persisted despite intensive medical therapy, including an antireflux diet. Preoperatively, all patients underwent 24-h pH monitoring, esophageal manometry, barium swallow, gastric emptying study, bronchoscopy, and upper endoscopy. NF was utilized in all cases, laparoscopically in 18. Before and after surgery, patients graded their cough severity using the Adverse Cough Outcome Survey (ACOS). Quality of life was measured using the Sickness Impact Profile (SIP).

Results

Postoperatively, 18 patients (86%) reported an improvement of their cough. G-CC considerably improved in 16/21 patients (76%), with complete resolution in 13 patients (62%). Mild to moderate improvement was found in 2 patients (10%). Patient-reported cough severity (ACOS) and quality of life (SIP) both significantly improved early (6–12 weeks) postoperatively and persisted during the long-term (1 year) follow-up. The average hospital length of stay was 1.78±0.2 (1–4) days for the laparoscopic (n=18) and 6.3±1.2 (4–8) days for the open surgery (n=3) groups.

Conclusion

Twenty-four-hour esophageal pH monitoring is a valuable tool for preoperative cough—reflux correlation. Antireflux surgery is effective in carefully selected patients whose refractory CC is attributable only to GERD. NF controls the severity of cough while improving the quality of life. Outcomes are further enhanced using laparoscopic procedures with shorter hospital stays.

Key words

Chronic cough Gastroesophageal reflux-induced respiratory symptoms Esophageal pH monitoring Laparoscopy Nissen fundoplication 

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Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Y. W. Novitsky
    • 1
  • J. K. Zawacki
    • 2
  • R. S. Irwin
    • 2
  • C. T. French
    • 2
  • V. M. Hussey
    • 1
  • M. P. Callery
    • 1
  1. 1.Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA

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