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Research Article
Ram Dickman
Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Background
Chronic cough is considered to be part of the gastroesophageal reflux disease (GERD) spectrum. However, the response rate to standard dose proton pump inhibitors (PPI's) is poor. Our aim was to evaluate the response rate of chronic cough to an extended course of high dose PPI's and to identify predictors of treatment response.
Methods
This prospective study included adult nonsmoking patients with chronic cough, normal spirometry, normal upper endoscopy and with no evidence of postnasal drip (PND). Treatment consisted of high dose PPI's (esomeprazole, 40mg b.i.d.) for 4 months. Primary end point was the reduction of the Reflux Symptoms Index (RSI), Leicester Cough Questionnaire (LCQ) and the Reflux Findings Score (RFS) by more than 50% at 4 months from baseline.
Results
Forty-one patients (39% female; mean age 55.9 ± 15.19 years) were enrolled, most of them with mean cough duration of more than 1 year. The primary end point was achieved in 39% of patients. Predictors of response included higher educational level (p = 0.035), hyperemia of the arytenoids and the postcricoid area (p = 0.026), and hoarseness (p < 0.01). No difference was found in the frequency of heartburn and regurgitation between responders and nonresponders. More complaints of difficulty in swallowing were reported by nonresponders (p < 0.01).
Conclusion
A therapeutic benefit of high dose PPI's for chronic cough cannot be dismissed, especially in patients with hoarseness, and arytenoid or postcricoid hyperemia. Prolonged high dose therapy may be warranted.
Keywords
Chronic cough, Gastroesophageal reflux disease, Hoarseness, Postcricoid hyperemia, Proton pump inhibitors
Figure 1
Figure 2
No competing interests reported.
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A new preprint design is coming!
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research Article
Ram Dickman
Division of Gastroenterology, Rabin Medical Center, Beilinson Campus and Sackler Faculty of Medicine, Tel Aviv University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 08 Apr, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Chronic cough is considered to be part of the gastroesophageal reflux disease (GERD) spectrum. However, the response rate to standard dose proton pump inhibitors (PPI's) is poor. Our aim was to evaluate the response rate of chronic cough to an extended course of high dose PPI's and to identify predictors of treatment response.
Methods
This prospective study included adult nonsmoking patients with chronic cough, normal spirometry, normal upper endoscopy and with no evidence of postnasal drip (PND). Treatment consisted of high dose PPI's (esomeprazole, 40mg b.i.d.) for 4 months. Primary end point was the reduction of the Reflux Symptoms Index (RSI), Leicester Cough Questionnaire (LCQ) and the Reflux Findings Score (RFS) by more than 50% at 4 months from baseline.
Results
Forty-one patients (39% female; mean age 55.9 ± 15.19 years) were enrolled, most of them with mean cough duration of more than 1 year. The primary end point was achieved in 39% of patients. Predictors of response included higher educational level (p = 0.035), hyperemia of the arytenoids and the postcricoid area (p = 0.026), and hoarseness (p < 0.01). No difference was found in the frequency of heartburn and regurgitation between responders and nonresponders. More complaints of difficulty in swallowing were reported by nonresponders (p < 0.01).
Conclusion
A therapeutic benefit of high dose PPI's for chronic cough cannot be dismissed, especially in patients with hoarseness, and arytenoid or postcricoid hyperemia. Prolonged high dose therapy may be warranted.
Figure 1
Figure 2
No competing interests reported.
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