PTH-123 Chronic cough and gord: the tip of the iceberg?

Abstract

Introduction Chronic cough affects 9%–33% of European and US populations.1 Gastro-oesophageal reflux disease (GORD) has emerged as an important cause,2 with high resolution manometry (HRM) and 24 hour pH monitoring a vital diagnostic tool. Methods We retrospectively audited referrals from respiratory physicians for chronic cough from February 2015-November 2016. 105 patients were referred, with 85 undergoing HRM/pH studies which were performed using Sandhill Scientific equipment. Results HRM/pH studies showed a mean upper oesophageal sphincter pressure of 34.7 mmHg, with 47% having a hypotensive UOS. Mean lower oesophageal sphincter pressure was 19.1 mmHG, with 33% having a hypotensive LOS. Mean percentage upright oesophageal acid exposure was 5.3%, with 24% having excessive exposure (>6.3%). Mean supine oesophageal acid exposure was 4.4%, with 32% having excessive exposure (>1.2%). The mean DeMeester score was 17.6, with 28% having a positive score (>14.7). See table 1 for full physiology results. 14.3% patients were referred for anti-reflux surgery (ARS) after HRM. 60% had hypotensive UOS, 67% hypotensive LOS, 47% upright acid exposure >6.3%, 60% supine acid exposure >1.2%, 67% DeMeester score >14.7% and 60% positive symptom association. There were no statistically significant differences between those undergoing ARS and those not for sex, age, BMI or UOS pressures. However LOS pressure,% upright/supine acid exposure and DeMeester score were significantly different (p=0.03, Conclusions GORD is a potentially important cause of chronic cough, affecting 24%–32% of patients by supine/upright acid exposure or DeMeester score. 47% have a hypotensive UOS, suggesting the cough may represent pharyngeal dysfunction and/or non-acid reflux. ~15% underwent ARS, a higher conversion rate than the colorectal 2-week-wait pathway (5%–10%), despite mixed evidence of the effectiveness of ARS for extra-oesophageal manifestations of GORD.3 4 References . Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008Apr 19;371(9621):1364–74. . Hopper AD. Improving the diagnosis and management of GORD in adults. Practitioner. 2015Apr;259(1781):27–32. . Tolone S, Del Genio G, Docimo G, Brusciano L, del Genio A, Docimo L. Objective outcomes of extra-esophageal symptoms following laparoscopic total fundoplication by means of combined multichannel intraluminal impedance pH-metry before and after surgery. Updates Surg. 2012Dec;64(4):265–71. . Sidwa F, Moore AL, Alligood E, Fisichella PM. Surgical Treatment of Extraesophageal Manifestations of Gastroesophageal Reflux Disease. World J Surg. 2017May 15.