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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2002 June;41(2):57-62
Persistent cough and asyntomatic gastro-oesophageal reflux
Colangeli A., Farina E., Battista B., Saltarelli P.
Background. Persistent coughing represents a major dilemma in daily clinical practice. As numerous cases show it to be related to asymptomatic gastroesophageal reflux (GER), we have attempted to verify this assumption.
Methods. We recruited a group of 26 subjects with this symptomatology. Average age was 32, both sexes, most amateur sports practitioners and non-smokers. Clinical examination and chest radiology, spirometry, metacholine bronchial challenge, respiratory prick tests and hemato-chemical examinations enabled us to identify, and exclude from the present study, subjects with respiratory pathology. Gastroesophageal pH was measured by positioning a nasogastric probe fitted with two pH (gastric and esophageal) detectors transnasally and recording pH continuously for the 24 hours thereafter. Reflux episodes were considered pathological if a reduction in esophageal pH to below 4.0 for more than 5 minutes was observed. Episodes thus evidenced were related to symptomatology and posture. The study protocol included the administration of anti-protonic and anti-prokinetic drugs, repetition of pHmetry after 1-2 months of treatment and the performance of gastroscopy in doubtful cases.
Results. This protocol was modified following the inclusion of the first 6 cases since right from the start we observed a rapid improvement in symptomatology to the extent that any other assessment was rendered superfluous. Twentythree of 26 subjects proved positive with a variable extent of regurgitation episodes. Gastroscopy, which was carried out in 6 subjects, showed a hiatal hernia in one case only and this was already known, while it showed no noteworthy signs in the other cases.
Conclusions. The data reported indicate that GER is a little known cause to be sought actively in the event of persistent coughing, that pHmetry is the gold standard, while gastroscopy is of less importance. The mechanism with which GER can cause coughing is not known, but it seems that it is to be sought in an esophageo-tracheobronchial nervous reflex stimulated by the gastric environment and mediated by the vagus nerve. There do not appear to be important microinhalations of gastric content, considering the normality of the radiographic findings.