Skip to main content

Effectiveness of Antireflux Surgery for the Cure of Chronic Cough Associated with Gastroesophageal Reflux Disease

World Journal of Surgery volume 39, pages 208–215 (2015)Cite this article

Abstract

Background

The effectiveness of surgical therapy for chronic cough secondary to gastroesophageal reflux disease remains controversial. The purpose of this study was to assess the efficacy of surgery and to identify the preoperative clinical profile that could predict the positive effects of treatment on chronic cough.

Study Design

Of 299 patients who underwent antireflux surgery between 1995 and 2010, 67 patients were affected by chronic cough and typical symptoms. In addition, 83 patients with typical symptoms were selected to form the control group, according to the parameters of age, sex, and the period of surgical activity. Preoperatively, all patients underwent a workup, including symptom assessment, barium swallow, upper gastrointestinal endoscopy, esophageal manometry, and 24-h pH recording or intraluminal impedance/pH monitoring in the absence of esophagitis. Patients with chronic cough also were administered a high-resolution computed tomography scan of the chest, a methacholine challenge test, and spirometry. Surgery was performed on patients positive for gastroesophageal reflux disease and negative for pulmonary diseases. The patients were followed up for a median of 84 months after surgery.

Results

No significant differences in preoperative reflux symptoms or esophagitis were found between the two groups. After surgery, chronic cough was absent in 57 (85 %) patients. Of the ten patients who still reported chronic cough, reflux symptoms relapsed in five, two of whom developed esophagitis. In the other five patients, typical symptoms were absent, and their chronic cough had improved but had not disappeared.

Conclusions

Surgery is effective for the treatment of chronic cough secondary to gastroesophageal reflux disease, particularly if associated with severe and long-standing typical symptoms.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Iqbal M, Batch AJ, Spychal RT, Cooper BT (2008) Outcome of surgical fundoplication for extraesophageal (atypical) manifestations of gastroesophageal reflux disease in adults: a systematic review. J Laparoendosc Adv Surg Tech A 18(6):789–796

    PubMed  Article  Google Scholar 

  2. Novitsky Y, Zawacki JK, Irwin RS et al (2002) Chronic cough due to gastroesophageal reflux disease: efficacy of antireflux surgery. Surg Endosc 16:567–571

    CAS  PubMed  Article  Google Scholar 

  3. Irwin RS, Curley FJ, French CL (1990) Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 141(3):640–647

    CAS  PubMed  Article  Google Scholar 

  4. Tobin RW, Pope CE 2nd, Pellegrini CA et al (1998) Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 158(6):1804–1808

    CAS  PubMed  Article  Google Scholar 

  5. Mattioli S, Lugaresi ML, Di Simone MP et al (2004) The surgical treatment of the intrathoracic migration of the gastrooesophageal junction and of short oesophagus in gastrooesophageal reflux disease. Eur J Cardiothorac Surg 25:1079–1088

    PubMed  Article  Google Scholar 

  6. Mattioli S, Lugaresi ML, Costantini M et al (2008) The short esophagus: intraoperative assessment of esophageal length. J Thorac Cardiovasc Surg 136(4):834–841

    PubMed  Article  Google Scholar 

  7. Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 108(3):308–328

    PubMed  Article  Google Scholar 

  8. Irwin RS (2006) Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):1S–292S

    PubMed Central  PubMed  Article  Google Scholar 

  9. Horvath KD, Swanstrom LL, Jobe BA (2000) The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery. Ann Surg 232:630–640

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. Waring JP, Lacayo L, Hunter J et al (1995) Chronic cough and hoarseness in patients with severe gastrooesophageal reflux disease. Digest Dis Sci 40:1093–1097

    CAS  PubMed  Article  Google Scholar 

  11. Patti MG, Arcerito M, Tamburini A et al (2004) Effect of laparoscopic fundoplication on gastrointestinal reflux disease-induced respiratory symptoms. J Gastrointest Surg 4:143–149

    Article  Google Scholar 

  12. Chen RYM, Thomas RJS (2000) Results of laparoscopic fundoplication where atypical symptoms coexist with oesophageal reflux. Aust N Z J Surg 70:840–842

    CAS  PubMed  Article  Google Scholar 

  13. Ekstrom T, Johansson KE (2000) Effects of antireflux surgery on chronic cough and asthma in patients with gastrooesophageal reflux disease. Respir Med 94:1166–1170

    CAS  PubMed  Article  Google Scholar 

  14. Thoman DS, Hui TT, Spyrou M, Phillips EH (2002) Laparoscopic antireflux surgery and its effect on cough in patients with gastro-oesophageal reflux disease. J Gastrointest Surg 6:17–21

    PubMed  Article  Google Scholar 

  15. Greason KL, Miller DL, Deschamps C et al (2002) Effects of antireflux procedures on respiratory symptoms. Ann Thoracic Surg 73:381–385

    Article  Google Scholar 

  16. Duffy JP, Maggard M, Hiyama DT et al (2003) Laparoscopic Nissen fundoplication improves quality of life in patients with atypical symptoms of gastro-oesophageal reflux. Am Surg 69:833–838

    PubMed  Google Scholar 

  17. Allen CJ, Anvari M (2004) Does laparoscopic fundoplication provide long-term control of gastroesophageal reflux related cough? Surg Endosc 18(4):633–637

    CAS  PubMed  Article  Google Scholar 

  18. Ciovica R, Dadenstatter M, Klingler A et al (2005) Laparoscopic antireflux surgery provides excellent results and quality of life in gastro-oesophageal reflux disease with respiratory symptoms. J Gastrointest Surg 9:633–637

    PubMed  Article  Google Scholar 

  19. Rakita S, Villadolid D, Thomas A et al (2006) Laparoscopic Nissen fundoplication offers high patient satisfaction with relief of extraoesophageal symptoms of gastro-oesophageal reflux disease. Am Surg 72:207–212

    PubMed  Google Scholar 

  20. Patterson RN, Mainie I, Rafferty G et al (2009) Nonacid reflux episodes reaching the pharynx are important factors associated with cough. J Clin Gastroenterol 43(5):414–419

    PubMed  Article  Google Scholar 

  21. Naik RD, Vaezi MF (2013) Extra-esophageal manifestations of GERD: who responds to GERD therapy? Curr Gastroenterol Rep 15(4):318

    PubMed  Article  Google Scholar 

  22. Vaezi MF (2004) Laryngitis and gastroesophageal reflux disease: increasing prevalence or poor diagnostic tests? Am J Gastroenterol 99(5):786–788

    PubMed  Article  Google Scholar 

  23. Francis DO, Goutte M, Slaughter JC et al (2011) Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux. Laryngoscope 121(9):1902–1909

    PubMed  Google Scholar 

  24. Hampel H, Abraham NS, El-Serag HB (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 143(3):199–211

    PubMed  Article  Google Scholar 

  25. Corley DA, Kubo A (2006) Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol 101(11):2619–2628

    PubMed  Article  Google Scholar 

  26. El-Serag H (2008) The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci 53(9):2307–2312

    PubMed Central  PubMed  Article  Google Scholar 

  27. Fisichella PM, Patti MG (2009) Gastroesophageal reflux disease and morbid obesity: is there a relation? World J Surg 33(10):2034–2038. doi:10.1007/s00268-009-0045-z

    PubMed  Article  Google Scholar 

  28. Tibbling L, Gibellino FM, Johansson KE (1995) Is mis-swallowing or smoking a cause of respiratory symptoms in patients with gastroesophageal reflux disease? Dysphagia 10:113–116

    CAS  PubMed  Article  Google Scholar 

  29. Stein MR (2003) Possible mechanisms of influence of esophageal acid on airway hyperresponsiveness. Am J Med 115(Suppl 3A):55S–59S

    CAS  PubMed  Article  Google Scholar 

  30. Irwin RS, Zawacki JK, Wilson MM et al (2002) Chronic cough due to gastroesophageal reflux disease: failure to resolve despite total/near-total elimination of esophageal acid. Chest 121:1132–1140

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Affiliations

  1. Division of Thoracic Surgery, Center for the Study and Therapy of Diseases of the Esophagus, Alma Mater Studiorum - University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy

    Marialuisa Lugaresi, Fabio Baldi & Sandro Mattioli

  2. GVM Care and Research, Cotignola, Italy

    Marialuisa Lugaresi, Fabio Baldi & Sandro Mattioli

  3. Ph.D. Course in Pneumo-Cardio-Thoracic Sciences, XXIII Cycle, Alma Mater Studiorum - University of Bologna, Bologna, Italy

    Beatrice Aramini

  4. Thoracic Surgery Unit, University of Perugia, Perugia, Italy

    Niccolò Daddi

Authors
  1. Marialuisa Lugaresi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beatrice Aramini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niccolò Daddi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabio Baldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandro Mattioli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandro Mattioli.

Additional information

ClinicalTrials.gov ID NCT01899183; https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0004BDN&selectaction=View&uid=U0000GED&ts=3&cx=-773yj2.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lugaresi, M., Aramini, B., Daddi, N. et al. Effectiveness of Antireflux Surgery for the Cure of Chronic Cough Associated with Gastroesophageal Reflux Disease. World J Surg 39, 208–215 (2015). https://doi.org/10.1007/s00268-014-2769-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2769-7

Keywords

  • Esophagitis
  • Gastroesophageal Reflux Disease
  • Reflux Esophagitis
  • Chronic Cough
  • Reflux Symptom