IS THE CHRONIC COUGHER A REFLUXER?
Thirteen adult patients with chronic cough of at least 2 months duration were evaluated with ambulatory esophageal pH monitoring (single probe). Thorough pulmonary evaluation ruled out asthma, postnasal drip, chronic bronchitis, allergic rhinitis, and other “pulmonary causes” of chronic cough. Smokers were excluded, as were patients with a prior history of gastroesophageal reflux. All chest x‐rays were normal. The pH probes were placed 10 cm above the lower esophageal sphincter (LES), determined by pH step‐up, by means of a pull‐through technique. Patients were not endoscoped and did not have barium radiographs or manometry. Symptom diaries were kept for esophageal symptoms, cough, medications, and meals. Age‐ and sex‐matched controls (N = 9) were studied in similar fashion. Coughers had an increased total reflux time (pH < 4) and a greater number of reflux episodes than did controls (p < 0.01). Six of 13 had abnormal total acid exposure time, as evaluated by standard normal criteria with the probe 5 cm above the LES (1). In 80% of reflux episodes, patients were upright and in 20%, supine. Total upright and supine reflux time was not stated. Mean reflux episodes were 115 ± 32 (SE), range 18‐338. Cough occurred simultaneously with 13% of reflux episodes, and occurred within 5 min with 35%. Reflux episodes were seen within 5 min in 90% of cough episodes. Despite the high frequency of reflux events, only two of 13 patients reported heartburn (eight total episodes, all post‐prandial). The relationship of cough to heartburn in these few episodes was not stated. Copyright © 1992, Wiley Blackwell. All rights reserved
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