GASTROENTEROLOGY ARTICLE OF THE WEEK
March 27, 2008
Chandra KM, Harding SM. Therapy insight: Treatment of gastroesophageal reflux in adults with chronic cough. Nat Clin Pract Gastroenterol Hepatol 2007;4:604-613.
1. Evaluation of a patient with chronic cough felt to be secondary to GER should include
a. Normal chest X-ray
b. Bronchial biopsies
c. Elimination of all ACE inhibitors
d. Empiric therapy with antihistamines
e. Exclusion of asthma
f. Negative sputum for eosinophils
g. Normal chest CT scan
True or False
2. GER is the second most common cause of chronic cough
3. Up to 75% of patients who have GER-related cough do not have heartburn
4. At present, impedence testing is the only test capable of detecting non-acidic reflux as the cause of chronic cough.
5. Most patients with GER-related cough will have cough resolution within 2 weeks of starting bid PPI
6. Omeprazole may cause cough in about 1% of patients taking it.
7. The failure of acid suppression to eliminate cough indicates that GER is not the cause
8. Patients who respond to BID PPI therapy must remain on a bid schedule permanently
9. During esophageal pH monitoring, acid-cough correlation is more imporatnat than total esophageal acid contact time
10. Empiric therapy for GER-related cough should include life-style modifications as well as bid PPI, with the evening dose taken before bed
11. Patients who fail a treatment trial of PPI should undergo manometry and pH testing while taking PPI
12. Baclofen therapy has the potential for reducing non-acidic reflux