Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults

Abstract

PPI is not efficacious for cough associated with GORD symptoms in very young children (including infants) and should not be used for cough outcomes. There is insufficient data in older children to draw any valid conclusions. In adults, there is insufficient evidence to conclude definitely that GORD treatment with PPI is universally beneficial for cough associated with GORD. Clinicians should be cognisant of the period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Future paediatric and adult studies should be double-blind, randomised controlled and parallel-design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non-acid reflux.

Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease

“…Beyond establishing the presence of pathological refl ux, ambulatory refl ux monitoring may be used to determine whether the patient ' s symptoms are due to refl ux. Th e two most commonly used methods to evaluate the temporal association between refl ux episodes and symptoms are the symptom index (SI) ( 130 ) and the symptom-association signifi cant improvement in cough scores in those receiving PPI (standardized mean diff erence − 0.41, 95 % CI − 0.75 to − 0.07) ( 140 ). Th e experience with treating laryngeal symptoms attributed to refl ux disease is comparable.…”

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

“…67,68 A recent metaanalysis of 5 randomized, placebo-controlled trials in adult patients with chronic cough did not find sufficient evidence in favor of PPI therapy. 69 Hoarseness has also been considered to be an important extraesophageal manifestation of GERD. In a US populationbased study, the frequency of hoarseness in patients with weekly GERD symptoms was 23% compared with 11% for those without GERD symptoms.…”

Empirical Evaluation of Age Groups and Age-Subgroup Analyses in Pediatric Randomized Trials and Pediatric Meta-analyses

“…These pertained to the following: (1) acyclovir for treating varicella in otherwise healthy children and adolescents 58 ; (2) antibiotics for preventing complications in children with measles 62 ; (3) antibiotics for the prevention of acute and chronic suppurative otitis media in children 64 ; (4) gastroesophageal reflux treatment of prolonged nonspecific cough in children and adults 67 ; 104 ; and (11) vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. 105 The age ranges of the age-subgroup analyses in those pediatric metaanalyses varied substantially as described in Table 3.…”