COPENHAGEN — Chronic cough during an acid-suppressive regimen identifies patients who could benefit from impedance pH monitoring and possible surgical management, based on a review of 50 patients.
“A positive symptom index for nonacid reflux directs the selection of patients who will benefit from antireflux surgery,” Radu Tutuian, M.D., and associates wrote in a poster at the 13th United European Gastroenterology Week.
The investigators studied patients who had a persistent cough despite taking a proton-pump inhibitor twice a day. Eighteen patients also took a dose of a histamine2 receptor antagonist at night.
While their treatment continued, the patients were assessed by using combined, multichannel, intraluminal impedance and by pH monitoring.
The association between cough and reflux was judged positive if two criteria were met: a reflux episode preceded coughing by 5 minutes or less, which was called symptom index (SI) positive, and the symptom association probability was greater than 95%.
The testing identified 13 patients as being SI positive and 14 as positive for symptom association probability, reported Dr. Tutuian, a gastroenterologist at the Medical University of South Carolina in Charleston.
The patients who were SI positive were more likely to be younger and male, compared with the other patients studied. The SI-positive group was 54% male, with an average age of 41 years, compared with 17% males and an average age of 51 years among the others.
Six of the 13 SI-positive patients underwent laparoscopic Nissen fundoplication. After 2–17 months of follow-up (with a mean of 9 months), all 6 patients were off antisecretory treatment and were asymptomatic.
Impedance pH monitoring while on treatment should be done in patients with persistent symptoms despite treatment with a proton-pump inhibitor, the researchers concluded.