摘要
Background and aims: Acid gastro-oesophageal reflux is one of the most import ant causes of chronic cough. The response to acid suppression in these patients is not as good as in patients with heartburn but improvement with antireflux sur gery has been reported, suggesting the involvement of a non-acidic gastric comp onent in the refluxate. Less acidic reflux may produce symptoms such as regurgit ation or chest pain. We investigated whether chronic cough might be associated w ith weakly acidic reflux. Methods: We studied 28 patients with chronic cough usi ng 24 hour ambulatory pressure-pH-impedance monitoring.Manom- etry was used for precise recognition of cough and impeda- nce-pHmetry to detect acid (pH< 4), weakly acidic(pH 7-4), and weakly alkali ne (impedance drops, pH ≥7) reflux. A symptom association probability (SAP) ana lysis was performed for each type of reflux. Results: Analysis was completed in 22 patients with 24 cough events (5-92)/patient. The majority of cough events ( 69.4%) were considered “independent"of reflux whereas 30.6%occurred within tw o minutes of a reflux episode. Half of these (49%) were “reflux cough"sequence s, involving acid (65%), weakly acidic (29%), and weakly alkaline (6%) reflux. Ten patients (45%) ha d a positive SAP between reflux and cough: five with acid, two with acid and wea kly acidic, and three only with weakly acidic reflux.Conclusions: Ambulatory pre ssure-pH-impedance monitoring with S- AP analysis allowed precise determination of the temporal association between cough and gastro-oesophageal reflux(acid, weakly acidic, and weakly alkaline) a nd identification of a subgroup of patients with chronic cough clearly associate d with weakly acidic gastro-oesophageal reflux.
Background and aims: Acid gastro-oesophageal reflux is one of the most import ant causes of chronic cough. The response to acid suppression in these patients is not as good as in patients with heartburn but improvement with antireflux sur gery has been reported, suggesting the involvement of a non-acidic gastric comp onent in the refluxate. Less acidic reflux may produce symptoms such as regurgit ation or chest pain. We investigated whether chronic cough might be associated w ith weakly acidic reflux. Methods: We studied 28 patients with chronic cough usi ng 24 hour ambulatory pressure-pH-impedance monitoring.Manom- etry was used for precise recognition of cough and impeda- nce-pHmetry to detect acid (pH< 4), weakly acidic(pH 7-4), and weakly alkali ne (impedance drops, pH ≥7) reflux. A symptom association probability (SAP) ana lysis was performed for each type of reflux. Results: Analysis was completed in 22 patients with 24 cough events (5-92)/patient. The majority of cough events ( 69.4%) were considered “independent'of reflux whereas 30.6%occurred within tw o minutes of a reflux episode. Half of these (49%) were “reflux cough'sequence s, involving acid (65%), weakly acidic (29%), and weakly alkaline (6%) reflux. Ten patients (45%) ha d a positive SAP between reflux and cough: five with acid, two with acid and wea kly acidic, and three only with weakly acidic reflux.Conclusions: Ambulatory pre ssure-pH-impedance monitoring with S- AP analysis allowed precise determination of the temporal association between cough and gastro-oesophageal reflux(acid, weakly acidic, and weakly alkaline) a nd identification of a subgroup of patients with chronic cough clearly associate d with weakly acidic gastro-oesophageal reflux.
