Advertisement

Digestive Diseases and Sciences

, Volume 40, Issue 5, pp 1093–1097 | Cite as

Chronic cough and hoarseness in patients with severe gastroesophageal reflux disease

Diagnosis and response to therapy
  • J. Patrick Waring
  • Leonel Lacayo
  • John Hunter
  • Ellen Katz
  • Barbara Suwak
Esophageal, Gastric, And Duodenal Disorders

Abstract

Gastroesophageal reflux may be responsible for atypical symptoms such as chronic cough and hoarseness. Our aim was to evaluate and treat patients with severe gastroesophageal reflux and chronic cough or hoarseness with intensive antireflux therapy. Twenty-seven patients with typical heartburn symptoms in addition to significant cough or hoarseness were treated with aggressive antireflux therapy. We recorded the response of each symptom to the antireflux therapy. Two patients were lost to follow-up. Twenty of the 25 (80%) patients showed some improvement in cough or hoarseness, nine (36%) had no atypical symptoms at follow-up. The response of heartburn to therapy was strongly predictive of successful therapy for the atypical symptoms. Cough and hoarseness improved in only two of the five patients with residual heartburn symptoms compared to 18 of 20 patients with no heartburn (P<0.04). Only patients with no heartburn symptoms at follow-up had complete resolution of atypical symptoms. There were no important differences on ambulatory pH monitoring between partial and complete responders. Improvement in atypical reflux symptoms, such as chronic cough and hoarseness, is common with aggressive antireflux therapy. There are no findings on ambulatory esophageal pH monitoring that uniquely identify patients who are likely to respond to antireflux therapy.

Key words

gastroesophageal reflux antireflux therapy chronic cough hoarseness 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Traube M: The spectrum of the symptoms and presentations of gastroesophageal reflux disease. Gastroenterol Clin North Am 19:609–616, 1990PubMedGoogle Scholar
  2. 2.
    DeMeester TR, O'Sullivan GC, Bermudex G, Midell AI, Cimochowski GE, O'Drobinak J: Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 196:488–498, 1982PubMedGoogle Scholar
  3. 3.
    Peters L, Maas L, Petty D, Dalton C, Penner D, Wu W, Castell DO: Spontaneous noncardiac chest pain: Evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 94:878–886, 1988PubMedGoogle Scholar
  4. 4.
    Breumelhof R, Nadorp J, Akkermans LM, Smout AJ: Analysis of 24-hour esophageal pressure and pH data in unselected patients with non-cardiac chest pain. Gastroenterology 99:1257–1264, 1990PubMedGoogle Scholar
  5. 5.
    Lam HG, Dekker W, Kan G, Breedik M, Smout AJ: Acute noncardiac chest pain in a coronary care unit: Evaluation by 24-hour pressure and pH recording of the esophagus. Gastroenterology 102:448–452, 1992PubMedGoogle Scholar
  6. 6.
    Stahl WG, Beton RR, Brown CL, Johnson CS, Waring JP: High-dose ranitidine for patients with noncardiac chest pain and evidence of gastroesophageal reflux. South Med J 87:739–742, 1994PubMedGoogle Scholar
  7. 7.
    Achem SR, Kolts B, MacMath T, Newman FB, Burton L, Richter J: Coexisting nutcracker esophagus and reflux esophagitis: The effect of reflux therapy on symptoms and manometric features. Am J Gastroenterol 88:187–192, 1993PubMedGoogle Scholar
  8. 8.
    Singh S, Richter JE, Hewson EG, Sinclair JW, Hackshaw BT: The contribution of gastroesophageal reflux to chest pain in patients with coronary artery disease. Ann Intern Med 117:824–830, 1992PubMedGoogle Scholar
  9. 9.
    Sontag SJ, O'Connell S, Khandelwal S, Miller T, Nemchausky B, Schnell TG, Serlovsky R: Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. Gastroenterology 99:613–620, 1990PubMedGoogle Scholar
  10. 10.
    DeMeester TR, Bonavina L, Iascone C, Courtney JV, Skinner DB: Chronic respiratory symptoms and occult gastroesophageal reflux: A prospective clinical study and results of surgical therapy. Ann Surg 211:337–345, 1990PubMedGoogle Scholar
  11. 11.
    Perrin-Fayolle M, Gormand F, Braillon G, Lombard-Platet R, Vignal J, Azzar D, Forichon J, Adeleine P: Long-term results of surgical treatment for gastroesophageal reflux in asthmatic patients. Chest 96:40–45, 1989PubMedGoogle Scholar
  12. 12.
    McNally PR, Maydonovitch CL, Prosek RA, Collette RP, Wong PK: Evaluation of gastroesophageal reflux as a cause of idiopathic hoarseness. Dig Dis Sci 34:1900–1904, 1989PubMedGoogle Scholar
  13. 13.
    Weiner GJ, Kaufman JA, Wu WC, Cooper JB, Richter JE, Castell DO: Chronic hoarseness secondary to gastroesophageal reflux disease: Documentation with 24 hour ambulatory pH monitoring. Am J Gastroenterol 84:1503–1508, 1989PubMedGoogle Scholar
  14. 14.
    Irwin RS, Curley FJ, French CL: Chronic cough: The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 141:640–647, 1990PubMedGoogle Scholar
  15. 15.
    Ing AJ, Ngu MC, Breslin AB: Chronic persistent cough and clearance of esophageal acid. Chest 102:1668–1671, 1992PubMedGoogle Scholar
  16. 16.
    Katz PO: Ambulatory esophageal and hypopharyngeal pH monitoring in patients with hoarseness. Am J Gastroenterol 85:38–40, 1990PubMedGoogle Scholar
  17. 17.
    Jacob P, Kahrilas PJ, Herzon G: Proximal pH-metry in patients with reflux laryngitis. Gastroenterology 100:305–310, 1991PubMedGoogle Scholar
  18. 18.
    Waring JP, Hunter JG, Oddsdoti M, Wo J, Katz E: The preoperative evaluation of patients considered for laparoscopic antireflux surgery. Am J Gastroenterol 90:35–38, 1995PubMedGoogle Scholar
  19. 19.
    Kamel PL, Hanson D, Kahrilas PJ: Omeprazole for the treatment of posterior laryngitis. Am J Med 96:321–326, 1994PubMedGoogle Scholar
  20. 20.
    Paterson WG, Murat BW: Combined ambulatory esophageal manometry and dual-probe pH-metry in evaluation of patients with chronic unexplained cough. Dig Dis Sci 39:1117–1125, 1994PubMedGoogle Scholar
  21. 21.
    Dobhan R, Castell DO: Normal and abnormal proximal esophageal acid exposure: Results of ambulatory dual probe pH monitoring. Am J Gastroenterol 88:25–29, 1993PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • J. Patrick Waring
    • 2
    • 1
  • Leonel Lacayo
    • 2
    • 1
  • John Hunter
    • 2
    • 1
  • Ellen Katz
    • 2
    • 1
  • Barbara Suwak
    • 2
    • 1
  1. 1.Department of Surgery, Division of Gastrointestinal SurgeryEmory University School of MedicineAtlanta
  2. 2.Department of Internal Medicine, Division of Digestive DiseasesEmory University School of MedicineAtlanta

Personalised recommendations