Cough and GERD: Prevalence, Association and Effect of Gender in Uninvestigated and Untreated Patients Over Age 65

Abstract

Purpose: Cough has been reported as a symptom of gastroesophageal reflux disease (GERD). Since both cough and GERD increase with aging, we sought to evaluate the prevalence, association and the effect of gender between these disorders in a group of patients aged 65 and over. Methods: 300 consecutive patients over the age of 65 (mean 72 years, range 65-88, 46% female) who were referred for screening or surveillance colonoscopy but who had never undergone upper endoscopy and were not on antisecretory therapy underwent a series of questionnaires followed by a research upper endoscopy just prior colonoscopy. Patients were considered to have GERD if they had Barrett's esophagus (BE), erosive esophagitis (EE) or sufficient symptoms (heartburn or regurgitation occurring more than 2 times weekly or having been present for more than 5 years). An additional questionnaire (GSAS-distress) assessed the frequency and degree of cough-induced distress (not at all, somewhat, quite a bit or very much). Results: 82 of 300 (27%) subjects reported cough as a symptom (20 reported cough, but were not distressed; 46 were somewhat distressed; 12 quite a bit distressed; and 4 very much distressed). The reported frequency of cough varied from one to 75 times weekly. BE was present in 57 (19%), EE without BE in 43 (14%) and significant reflux symptoms without BE or EE in 57 (19%) patients. Thus, the majority had mucosal disease or symptoms consistent with GERD (157/300; 52%). Cough was more common in GERD (GERD positive 49/157; 31.2%, GERD negative 33/143; 23.1%, p = 0.006). Significant gender differences were noted. Men were more likely to have GERD (57.8% vs 43.0%, p<0.0001) whilst cough trended to be more common in women (24.2% in men, 28.9% in women, p = 0.09). In the subset of patients with GERD (n = 157), men were more likely to have mucosal disease (76.3% vs 45.3%, p<0.0001) but women were more likely to report cough (35.9% vs 28.0%, p<0.0001). Conclusion: GERD and cough are common and tend to be associated in subjects aged over 65 years. GERD was more common in men and more likely due to mucosal disease whereas the prevalence of cough was slightly increased in women, particularly those women with GERD. Further studies are required to determine causality between these common conditions. This research was supported by an industry grant from AstraZeneca.