Gastroesophageal Reflux Disease Associates More with Cough Than Hoarseness in Subjects Aged Over 65 Years

Abstract

Purpose: Both cough and hoarseness are often reported as symptoms of gastroesophageal reflux disease (GERD). All three tend to increase with advancing age, but whether one associates more with GERD is unknown. 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 and hoarsenessinduced distress (not at all, somewhat, quite a bit or very much). Results: 82 of 300 (27%) subjects reported cough and 51 (17%) reported hoarseness (30 had both cough and hoarseness). Most were at least somewhat distressed by their symptom(s). BE or intestinal metaplasia of the cardia 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%). Although cough was more common in GERD (GERD positive 31.2%, GERD negative 23.1%, p = 0.006), there was no difference in hoarseness between those with and without GERD (17.8 vs 16.1%). The percentage reporting cough increased with the frequency of GERD symptoms (p<0.0001), while there was no clear relationship between hoarseness and the frequency of GERD (Figure).Figure: No Caption available.Conclusion: GERD, cough and to a lesser extent hoarseness are common in subjects aged over 65 years. The frequency of GERD symptoms is predictive of the proportion of patients reporting cough, but not hoarseness. While care should be taken in attributing any atypical symptom to GERD, these data would suggest that this is especially true with hoarseness. This research was supported by an industry grant from AstraZeneca.