Chronic persistent cough and gastro-oesophageal reflux.

Ing, Alvin; Ngu, Meng C.; Breslin, A. B. X.

doi:10.1136/thx.46.7.479

Cited by 113 publications

(80 citation statements)

References 14 publications

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“…The explanation for the lack of significant improvement in cough during omeprazole treatment in these patients is that there were two whose cough worsened whilst on omeprazole and seven whose cough was relieved by omeprazole. Although it is widely accepted that GOR causes cough [1±7] there is also evidence that cough may promote GOR [8,11,13]. It has been proposed that a positive feedback cycle between cough and GOR might exist [8,11].…”

Section: Discussionmentioning

confidence: 99%

“…Although it is widely accepted that GOR causes cough [1±7] there is also evidence that cough may promote GOR [8,11,13]. It has been proposed that a positive feedback cycle between cough and GOR might exist [8,11]. Lack of symptoms in these patients when on placebo might be explained by omeprazole-induced suppression of such a cough-reflux selfperpetuating cycle.…”

Section: Discussionmentioning

confidence: 99%

“…There is also evidence that cough might promote GOR [13], probably by increasing the pressure gradient between the thorax and the abdomen or by causing transient lower oesophageal sphincter relaxation [8,11]. In fact, the presence of a coughreflux self-perpetuating cycle has been proposed [8,11].…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

View full text Add to dashboard Cite

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“…An association with GERD may occur in as many as 50% of patients with noncardiac chest pain (111), 78% of patients with chronic hoarseness (112), and 82% of patients with asthma (113). Chronic cough has also been associated with GERD (114,115). Gastroesophageal reflux may be induced by exercise and can either be asymptomatic or present with typical or atypical symptoms (116,117).…”

Section: Extraesophageal Manifestations Of Gerdmentioning

confidence: 99%

Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease

DeVault¹

1999

The American Journal of Gastroenterology

143

178

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PREAMBLEGuidelines for the diagnosis and treatment of gastroesophageal reflux disease (GERD) were published by the American College of Gastroenterology in 1995 (1). These and other guidelines undergo periodic review. Significant advances have been made in the area of GERD over the past several years, leading us to review and revise our previous guidelines statements. These advances have included an increase in our comfort with the chronic use of proton pump inhibitors and an increased acceptance of laparoscopic antireflux surgery, among other factors. These and the original guidelines are intended to apply to all physicians who address GERD and are intended to indicate the preferable, but not only acceptable, approach. Physicians must always choose the course best suited to the individual patient and the variables that exist at the moment of the decision. These guidelines are intended to apply to adult patients with the symptoms, tissue damage, or both that result from the reflux of gastric contents into the esophagus. For the purpose of these guidelines GERD is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.Both these and the original guidelines were developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee, and approved by the Board of Trustees. The world literature was reviewed extensively for the original guidelines and was once again reviewed using the National Library of Medicine database. All appropriate studies were reviewed and any additional studies found in the reference list of these papers were obtained and reviewed. Evidence was evaluated along a hierarchy, with randomized controlled trials given the greatest weight. Abstracts presented at national and international meetings were only used when unique data from ongoing trials were presented. When scientific data were lacking, recommendations were based on expert consensus. During preparation, the guidelines were reviewed

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“…A reflux episode began when the pH dropped below 4 and ended when the pH rose above this value. Cough and reflux episodes were deemed to bear a temporal relationship with one another if events occurred simultaneously or within 5 min of one another [13].…”

Section: Patient Evaluationmentioning

confidence: 99%

Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Böllert¹,

Paton²,

Marshall³

et al. 1999

Eur Respir J

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Mast cells and eosinophils may play a role in the pathophysiology of chronic cough in nonasthmatics. It is unknown, however, whether degranulation of these cells occurs in the airways of such patients.Thirty-five nonsmoking patients referred with a chronic nonproductive cough (mean cough duration 76.2 months) were evaluated using a comprehensive diagnostic protocol. Bronchoalveolar lavage (BAL) cell differentials and BAL histamine, tryptase and eosinophilic cationic protein (ECP) concentrations were determined. Ten nonsmoking healthy volunteers served as controls.Diagnostic subgroups were identified: eight postnasal drip syndrome (PNDS), seven cough variant asthma (CVA), seven gastro-oeseophageal reflux (GOR), seven dual aetiology and six idiopathic. Nonasthmatic coughers (NAC) were characterized as those patients without bronchial hyperresponsiveness on histamine challenge and whose cough had either responded to therapy for PNDS or GOR or failed to improve with antiasthma therapy. There was a significant increase in both eosinophil and mast cell numbers (p<0.05) and in histamine levels (p=0.027) when NAC patients were compared with controls. Tryptase and ECP levels were elevated in 7 of 23 and 6 of 23 NAC patients, respectively.In conclusion, airway inflammatory cell numbers are not only increased but also activated, suggesting an important role for airways inflammation in the pathophysiology of chronic nonproductive cough. Eur Respir J 1999; 13: 59±65.

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Chronic persistent cough and gastro-oesophageal reflux.

Cited by 113 publications

References 14 publications

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

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

Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease

Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

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