Background: In addition to heartburn and regurgitation, cough is a frequent nonspecific complaint of patients with gastroesophageal reflux disease (GERD). These patients often have other causes for chronic cough. The present study was undertaken to determine the frequency and causes of cough in unselected GERD patients and the effect of laparoscopic antireflux surgery (LAS) on cough symptoms.
Methods: We performed a prospective cohort study of unselected patients with GERD who underwent LAS between January 1, 1995 and May 31, 2000 in a large community teaching hospital. All patients underwent preoperative esophageal manometry, 24-hour pH monitoring, and chest x-ray. Mean follow up by independent physician interview was 27 months (range 3-68 months). For analysis, patients were grouped according to the presence (Group A) or absence (Group B) of at least 2 months of preoperative cough. A previously validated cough score incorporating severity and frequency was used to determine effect of LAS on cough.
Results: LAS was performed in 137 consecutive patients; 8 patients were lost to follow up and not included in analysis. There were no differences in esophageal manometry, 24-hour pH results, or percentage of patients with abnormal chest x-ray between groups. There was no statistically significant association between cough and preoperative heartburn, regurgitation, nausea, dysphagia, belching, bloating, or chest pain (p>.05). Typical reflux symptoms such as heartburn and regurgitation were improved in 95% of both groups. The average cough score in Group A improved from 9.2 to 1.2 after surgery (p=.00000002), with 34 patients (92%) reporting significant improvement and 24 patients (65%) reporting complete resolution of cough.
Conclusions: Chronic cough was present in 29% of patients undergoing LAS for GERD, and 59% had at least one other potential cause for their cough. Despite this, LAS eliminated or significantly improved cough in 92% of patients.
Causes of cough compared.
Group n Smoking Asthma Postnasal drip ACE-I Any cause
A 37 (29%) 10 (27%) 11 (30%) 12 (32%) 4 (11%) 22 (59%)
B 92 (71%) 18 (20%) 15 (16%) 8 (9%) 24 (26%) 36 (39%)
p, A vs. B 0.35 0.086 0.0008 0.058 0.011