Does hiatal hernia impact GER-related chronic cough?

Abstract

Gastroesophageal reflux (GER) is a known trigger of chronic cough (CC). Hiatal hernia (HH) may coexist with GER and CC. The aim of the study was to evaluate whether the presence of HH in chest computed tomography (CT) was related with more intense cough and worse response to anti-reflux therapy. This was a retrospective analysis of data on adults with GER-related CC managed in our cough center between 2017 and 2021. Patients with GER-related CC, who had chest CT performed and in whom follow up data were available were included. The presence and size of HH was estimated based on chest CT. All patients were treated with modification of diet and PPI. The response to anti-reflux treatment was assessed based on improvement in quality of life measured by Leicester Cough Questionnaire (LCQ). Fourty seven adults (29 F, 18M) with GER-related CC were included. HH was demonstrated in 12 patients (25.5%). Patients with GER-related CC and HH didn’t differ from those without HH in terms of clinical characteristics, cough intensity and duration or cough related quality of life. However, there was a difference between the response to anti-reflux therapy in these two groups with no improvement in LCQ and significant LCQ improvement in patients with and without HH, respectively. We found strong positive correlations between size of HH and cough intensity (rho=0.692, p=0.012), duration (rho=0.720, p=0.0083) and strong negative correlation between size of HH and increase in LCQ (rho = -0.737 p=0.009) in patients with GER-related CC and HH. Hiatal hernia may be related with worse response to anti-reflux treatment in patients with GER-related CC. The size of HH impacts on intensity and duration of GER-related CC.