TY - JOUR
T1 - Acoustic cough-reflux associations in chronic cough
T2 - Potential triggers and mechanisms
AU - Smith, Jaclyn A.
AU - Decalmer, Samantha
AU - Kelsall, Angela
AU - McGuinness, Kevin
AU - Jones, Helen
AU - Galloway, Simon
AU - Woodcock, Ashley
AU - Houghton, Lesley A.
PY - 2010/9
Y1 - 2010/9
N2 - Background & Aims: Central sensitization is thought to play a role in chronic cough and might explain the temporal association between cough and gastroesophageal reflux (GOR) in patients in whom non-GOR causes have been excluded. Using our novel simultaneous acoustic cough recording and impedance/pH monitoring technique, we aimed to explore this further by assessing such temporal associations and their relationship to the acidity, duration, and proximal extent of reflux and the presence of erosive disease and cough reflex sensitivity in unselected patients (ie, including non-GOR causes) with chronic cough. Methods: Twenty-four hour ambulatory acoustic cough monitoring with simultaneous impedance/pH recording was carried out in 71 unselected patients with chronic cough, aged 5164 years (47 female). In addition, all patients underwent cough reflex sensitivity testing to citric acid, and 66 patients underwent gastroscopy. Temporal associations between cough and reflux were expressed using the symptom association probability. Results: Seventy percent of patients exhibited temporal associations, with 48% having a positive symptom association probability (SAPR-C) for cough preceded by reflux (mainly distal), 56% a positive symptom association probability (SAP C-R (2 min)) for reflux preceded by cough, and 32% both. Moreover, SAPR-C positive patients had a more sensitive cough reflex (P = .03) but similar esophageal reflux exposure and erosive disease, together with similar prevalence of extraesophageal causes of cough compared with SAP R-C negative patients. Reflux immediately following cough was rare. Conclusions: Cough temporally associates with reflux irrespective of proposed diagnoses, may be self-perpetuating in some patients, and is likely to be driven by central processes.
AB - Background & Aims: Central sensitization is thought to play a role in chronic cough and might explain the temporal association between cough and gastroesophageal reflux (GOR) in patients in whom non-GOR causes have been excluded. Using our novel simultaneous acoustic cough recording and impedance/pH monitoring technique, we aimed to explore this further by assessing such temporal associations and their relationship to the acidity, duration, and proximal extent of reflux and the presence of erosive disease and cough reflex sensitivity in unselected patients (ie, including non-GOR causes) with chronic cough. Methods: Twenty-four hour ambulatory acoustic cough monitoring with simultaneous impedance/pH recording was carried out in 71 unselected patients with chronic cough, aged 5164 years (47 female). In addition, all patients underwent cough reflex sensitivity testing to citric acid, and 66 patients underwent gastroscopy. Temporal associations between cough and reflux were expressed using the symptom association probability. Results: Seventy percent of patients exhibited temporal associations, with 48% having a positive symptom association probability (SAPR-C) for cough preceded by reflux (mainly distal), 56% a positive symptom association probability (SAP C-R (2 min)) for reflux preceded by cough, and 32% both. Moreover, SAPR-C positive patients had a more sensitive cough reflex (P = .03) but similar esophageal reflux exposure and erosive disease, together with similar prevalence of extraesophageal causes of cough compared with SAP R-C negative patients. Reflux immediately following cough was rare. Conclusions: Cough temporally associates with reflux irrespective of proposed diagnoses, may be self-perpetuating in some patients, and is likely to be driven by central processes.
KW - Cough
KW - Gastroesophageal Reflux
KW - Impedance/Ph Monitoring
KW - Symptom Association Probability
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U2 - 10.1053/j.gastro.2010.06.050
DO - 10.1053/j.gastro.2010.06.050
M3 - Article
C2 - 20600028
AN - SCOPUS:77956161937
SN - 0016-5085
VL - 139
SP - 754
EP - 762
JO - Gastroenterology
JF - Gastroenterology
IS - 3
ER -