Chronic Cough as the Sole Presenting Manifestation of Gastroesophageal Reflux

Irwin, Richard S.; Zawacki, John K.; Curley, Frederick J.; French, Cynthia L.; Hoffman, Peter J.

doi:10.1164/ajrccm/140.5.1294

Cited by 209 publications

(111 citation statements)

References 6 publications

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“…Additionally, esophageal pH monitoring may be the only method of diagnosing GER in up to 32% of patients with reflux-induced cough (29). As symptoms of GER, such as heartburn, are frequently absent in patients with reflux-induced cough (21,30), therapeutic trials may be less useful if no symptoms of GER are present. The ReQuest is a valid and reliable tool for measuring GER symptoms (15), but other methods are required for the objective assessment of symptom severity and patient response to treatment.…”

Section: Discussionmentioning

confidence: 99%

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

et al. 2010

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: Salivary pH is associated with esophageal acid reflux and neutralization of esophageal acid. In this study, we assessed the association between nocturnal decline of salivary pH and airway hyperresponsiveness. Salivary pH was serially assessed in 9 patients with mild asthma (7 men and 2 women ; mean age 33.3 years ; mean % %predicted FEV1.0 89.4% %) and 10 healthy volunteers (6 men and 4 women ; mean age 31.2 years) using a pH indicator tape. The buffering capacity of saliva was defined as the median effective dose (ED50) for acidification of saliva with 0.01 N HCl, and airway responsiveness was defined as the dose of methacholine producing a 35% % fall in Grs (PD35-Grs). There was a significant correlation between the values obtained from the pH indicator tape and those obtained from the electrometric pH meter. Using the indicator tape for sequential monitoring, we observed a nocturnal fall (!pH) in salivary pH in all subjects. A significant correlation was found between airway hyperresponsiveness (PD35-Grs) and either !pH or ED50 in mildly asthmatic patients. Vagal reflux dysfunction might contribute to nocturnal salivary pH as well as to airway hyperresponsiveness in mild asthmatics. J. Med. Invest.

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Section: Discussionmentioning

confidence: 99%

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

et al. 2010

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“…cough goes away after specific therapy aimed at its cause) was not utilized at the inclusion. Secondly, it has been shown that GOR can be the cause of chronic cough even when the conventional variables in the pH monitoring are normal, if the cough is associated with a reflux episode [6]. Since we wanted to be certain that all the patients who were randomized really had GOR, these traditional variables were used to classify the patients.…”

Section: Discussionmentioning

confidence: 99%

Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole

Kiljander¹,

Salomaa²,

Hietanen³

et al. 2000

Eur Respir J

137

105

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Gastro-oesophageal reflux (GOR) is an important cause of chronic cough. There has been a lack of placebo-controlled trials treating GOR related chronic cough with antireflux therapy. The aim of this study was to determine the efficacy of omeprazole on GOR related chronic cough.After excluding other common causes of cough, oesophageal pH monitoring was performed on 48 patients with chronic cough. Twenty-nine patients found to have GOR were randomized in a double-blind fashion to receive omeprazole 40 mg o.d. or placebo for 8 weeks. After a 2-week washout period, patients were crossed over to the other treatment. Symptoms were recorded daily in a diary.Twenty-one patients completed both treatment periods. Cough (p=0.02) and gastric symptoms (p=0.003) improved significantly during the omeprazole treatment in twelve patients who received placebo during the first and omeprazole during the second 8-week period. In nine patients who received omeprazole during the first 8-week period, amelioration in cough reached statistical significance only after cessation of omeprazole. Gastric symptoms also remained minor during placebo in these nine patients.Omeprazole 40 mg o.d. seems to improve chronic cough in patients with gastrooesophageal reflux and the effect of omeprazole in ameliorating both cough and reflux symptoms continues after treatment ceases. Eur Respir J 2000; 16: 633±638.

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“…This increase was largely prevented by the tachykinin NK 1 and NK 3 receptor antagonists SR 140333 and SR 142801 (1-10 mg?kg -1 ). These results suggest that protein extravasation in the airways, as induced by intraoesophageal HCl infusion, is mainly dependent on the release of tachykinins, and that both NK 1 Gastro-oesophageal reflux is a common clinical disorder associated with a variety of respiratory symptoms, including chronic cough and bronchoconstriction [1][2][3][4]. It has been shown to be more frequent in people with asthma [4].…”

mentioning

confidence: 94%

Tachykinins and airway microvascular leakage induced by HCl intra-oesophageal instillation

Daoui

D’Agostino²,

Gallelli³

et al. 2002

Eur Respir J

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Gastro-oesophageal reflux is a common clinical disorder associated with a variety of respiratory symptoms, including chronic cough and exacerbation of asthma. In this study, the potential role of acid-induced tachykinin release was examined in guinea pigs and rabbits, by examining the effects of the tachykinin NK1and NK3receptors antagonists (SR 140333 and SR 142801, respectively) (1–10 mg·kg−1) on plasma protein extravasation induced in airways by hydrochloric acid (HCl) infusion in the oesophagus.Guinea pigs were anaesthetised with urethane, while rabbits were subject to neuroleptoanalgesia with hypnorm. Airway vascular leakage was evaluated by measuring extravasation of Evans blue dye. All animals were pretreated with atropine (1 mg·kg−1i.p.), propranolol (1 mg·kg−1i.p.), phosphoramidon (2.5 mg·kg−1i.v.) and saline or tachykinin receptor antagonists (1–10 mg·kg−1i.p.).Infusion of 1 N HCl into the oesophagus led to a three- and five-fold increase in plasma extravasation in the main bronchi and trachea, respectively. This increase was largely prevented by the tachykinin NK1and NK3receptor antagonists SR 140333 and SR 142801 (1–10 mg·kg−1).These results suggest that protein extravasation in the airways, as induced by intra-oesophageal HCl infusion, is mainly dependent on the release of tachykinins, and that both NK1and NK3tachykinin receptors are involved. The results suggest that HCl-induced sensory nerve stimulation may act in the periphery on intermediate neurons and/or ganglia where NK3receptors have been shown to play an important role.

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Chronic Cough as the Sole Presenting Manifestation of Gastroesophageal Reflux

Cited by 209 publications

References 6 publications

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole

Tachykinins and airway microvascular leakage induced by HCl intra-oesophageal instillation

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