Chronic cough due to gastroesophageal reflux disease - Failure to resolve despite total/near-total elimination of esophageal acid

Background: While medical therapy may fail to improve cough due to gastroesophageal reflux disease (GERD), it is not known if inadequate esophageal acid suppression is responsible. Methods: In a prospective, before-and-after interventional trial, we assessed the effects of antireflux surgery in eight patients whose chronic coughs were due to GERD resistant to intensive medical therapy. All patients met a profile predicting that cough was likely due to GERD and had an initial positive 24-h esophageal pH monitoring study, and then underwent serial 24-h esophageal pH monitoring on gradually intensified medical therapy until the percentage of time that esophageal pH was < 4 was zero and there were no acid reflux events > 4 min. The effects of medical and surgical therapy on cough were assessed clinically by a visual analog scale (VAS) and the Adverse Cough Outcome Survey (ACOS). Results: Before surgery (median, 23.7 days), patients still complained or cough, VAS score was 73.1 +/- 6.1, and ACOS score was 15.0 +/- 1.1. After surgery (median, 41.2 days and 1 year), cough improved in all, VAS score decreased to 19.1 +/- 8.3 and 22.6 +/- 8.1 (p = 0.001), respectively, and ACOS score decreased to 2.0 +/- 1.3 and 3.6 +/- 2.3, respectively (p = 0.002). Conclusions: Antireflux surgery can improve chronic cough due to GERD resistant to intensive medical therapy. There is a clinical profile that can predict when GERD is the likely cause or cough. GERD cannot be excluded on clinical grounds as the potential cause of cough: The term acid reflux disease, when applied to chronic cough due to GERD, can be a misnomer.