The diagnostic role of triple endoscopy in pediatric patients with chronic cough

Fracchia, M. Shannon; Diercks, Gillian R.; Cook, Anna; Hersh, Cheryl; Hardy, Stephen C.; Hartnick, Marina; Hartnick, Christopher J.

doi:10.1016/j.ijporl.2018.10.017

Cited by 28 publications

(29 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In line with this, a retrospective study of adult eosinophilic esophagitis patients identified baseline abdominal pain to be predictive of response to topical corticosteroids [27]. Furthermore, eosinophilic esophagitis is increasingly being recognized to be a differential diagnosis for chronic cough in children [28,29]. In contrast, although dysphagia, the defining symptom of eosinophilic esophagitis, was also a patient-reported parameter that lent stability to the model, its contribution was much lower than the aforementioned symptoms of cough and local pain.…”

Section: Discussionmentioning

confidence: 92%

Patient-Reported Outcomes and Blood-Based Parameters Identify Response to Treatment in Eosinophilic Esophagitis

et al. 2020

View full text Add to dashboard Cite

Background Noninvasive methods to assess treatment response in eosinophilic esophagitis are needed. Aims Our aim was to determine whether a blood-based biomarker panel centered on immune parameters could identify histologic response to treatment in eosinophilic esophagitis patients. Methods A pilot study involving adult patients with active eosinophilic esophagitis recruited at two Ear, Nose, Throat clinics in Sweden was designed. The patients ( n = 20) donated blood and esophageal biopsies and filled in three questionnaires before and after a 2-month course of topical corticosteroids. Blood samples were analyzed for absolute levels of granulocytes and T cells and the fractions of eosinophils expressing 10 different surface markers by flow cytometry. All data were analyzed by multivariate methods of pattern recognition. Results Multivariate modeling revealed that a combination of 13 immune parameters and 10 patient-reported outcome scores were required to create a model capable of separating responders ( n = 15) from non-responders ( n = 5). Questions regarding symptoms of esophageal dysfunction and capacity to eat certain foods from two of the questionnaires were discriminatory in the multivariate model, as were absolute counts of T cells, eosinophils, and eosinophil expression of activation markers and cell adhesion molecules. Conclusions A combination of blood-based immune parameters and directed questions may prove helpful to monitor response to treatment, perhaps reducing the need for repeat endoscopies in eosinophilic esophagitis patients in the future.

show abstract

Section: Discussionmentioning

confidence: 92%

Patient-Reported Outcomes and Blood-Based Parameters Identify Response to Treatment in Eosinophilic Esophagitis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…5,47,48 Recently, a multidisciplinary "triple" endoscopy has been proposed as a useful investigative tool for patients with recalcitrant aero-digestive complaints like chronic cough. 49 In their retrospective study, the authors reported that a rigid upper airway evaluation, a flexible bronchoscopy, bronchoalveolar lavage, and an endoscopy with biopsies performed by a gastroenterologist could provide more than one diagnosis, usually missed by one single procedure. 49 Finally, if an extensive evaluation fails to clarify the etiology of chronic cough, somatic cough disorder such as habit cough, tic cough, and a psychogenic cough must be hypothesized, and counseling or referral to a psychologist/ psychiatrist has been suggested in the diagnostic management.…”

Section: Refer To Specialistmentioning

confidence: 99%

“…49 In their retrospective study, the authors reported that a rigid upper airway evaluation, a flexible bronchoscopy, bronchoalveolar lavage, and an endoscopy with biopsies performed by a gastroenterologist could provide more than one diagnosis, usually missed by one single procedure. 49 Finally, if an extensive evaluation fails to clarify the etiology of chronic cough, somatic cough disorder such as habit cough, tic cough, and a psychogenic cough must be hypothesized, and counseling or referral to a psychologist/ psychiatrist has been suggested in the diagnostic management. 5,6 Although the habit cough is featured by a repetitive cough with barking or honking characteristics, and absence of symptom once asleep, these characteristics should be not used as a marker of habit cough.…”

Section: Refer To Specialistmentioning

confidence: 99%

Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

Marseglia

Manti

Chiappini

et al. 2021

aei

View full text Add to dashboard Cite

The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a “wait and see” approach, consisting of parental reassurance and close clinical observation, also due to interprofessional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a “wait and see” approach.Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family. Further high-quality randomized controlled trials are needed to validate this algorithm’s performance in real clinical practice.

show abstract

“…By 2007, Decalmer et al reported that bronchoscopy revealed abnormalities in 11% of patients with chronic cough of unknown cause (28). In 2019, Fracchia et al investigated the role of endoscopy in the diagnosis of chronic cough in 243 children who underwent bronchoscopy, gastroscopy, and laryngoscope; their results showed 67.5% of children had abnormal bronchoscopical findings (29). These results indicate that increasing patients require bronchoscopy for the identification of cause of chronic cough, and bronchoscopy is likely to become a routine examination for chronic cough patients in the future.…”

Section: Role Of Bronchoscopy In Chronic Coughmentioning

confidence: 99%

Should computed tomography and bronchoscopy be routine examinations for chronic cough?

Niu

2020

J Thorac Dis

View full text Add to dashboard Cite

Chronic cough is a common symptom of many diseases. Guidelines on cough from different countries recommend chest X-ray as the first-line examination. However, as compared to computerized tomography (CT), chest X-ray is insensitive in the diagnosis of many diseases. We speculate that CT is more helpful in excluding the causes of long-term cough, such as bronchial tumors and pulmonary interstitial diseases, which prevents patients from receiving unnecessary examinations and diagnostic treatments for chronic cough. In addition, a single chest CT is safe and affordable in some regions. Therefore, chest CT may be recommended as a first-line examination for patients with chronic cough. In addition, although bronchoscopy is employed as a further examination for chronic cough, it plays an important role in the diagnosis of chronic cough, especially in rare bronchial diseases such as amyloidosis and foreign body inhalation. Induced sputum cytology was not accepted as a necessary examination for chronic cough, but it becomes a first-line examination until physicians recognize that non-asthmatic eosinophilic bronchitis is a common cause of chronic cough. Therefore, we speculate that the roles of chest CT and bronchoscopy in the identification of causes of chronic cough are increasingly important; in some regions, or for patients suspicious for uncommon causes of chronic cough, CT and bronchoscopy are recommended as first-line examinations.

show abstract

The diagnostic role of triple endoscopy in pediatric patients with chronic cough

Cited by 28 publications

References 12 publications

Patient-Reported Outcomes and Blood-Based Parameters Identify Response to Treatment in Eosinophilic Esophagitis

Patient-Reported Outcomes and Blood-Based Parameters Identify Response to Treatment in Eosinophilic Esophagitis

Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

Should computed tomography and bronchoscopy be routine examinations for chronic cough?

Contact Info

Product

Resources

About