Successful resolution of refractory chronic cough induced by gastroesophageal reflux with treatment of baclofen

Xianghuai Xu,Siwei Liang,Qiang Chen,Zhongmin Qiu,Hanjing Lü

doi:10.1186/1745-9974-8-8

Abstract

Gastroesophageal reflux induced cough is a common cause of chronic cough, and proton pump inhibitors are a standard therapy. However, the patients unresponsive to the standard therapy are difficult to treat and remain a challenge to doctors. Here, we summarized the experience of successful resolution of refractory chronic cough due to gastroesophageal reflux with baclofen in three patients. It is concluded that baclofen may be a viable option for gastroesophageal reflux induced cough unresponsive to proton pump inhibitor therapy.

Highlights

Gastroesophageal reflux induced cough (GERC) is a common cause of chronic cough and accounts for 541% of chronic cough. [1] proton pump inhibitors are a standard therapy for GERC, some patients do not respond to the antireflux medical treatment and remain a challenge to doctors
In the patients with presumptive GERC whose cough persists despite proton pump inhibitors therapy, three possibilities arise to explain the continuing cough: 1. the gastric acid may be incompletely suppressed, and the patients are having continuing acid reflux that causes cough by microaspiration or esophageal-tracheobronchial reflex [1]. 2. non-acid reflux is producing cough
It is proposed that cough due to non-acid reflux is resistant to proton pump inhibitors since they only reduce the pH of the refluxate but not the amount and the rate of reflux episodes [2]. 3. the ongoing cough is not related to any continuing reflux

Summary

Introduction

Gastroesophageal reflux induced cough (GERC) is a common cause of chronic cough and accounts for 541% of chronic cough. [1] proton pump inhibitors are a standard therapy for GERC, some patients do not respond to the antireflux medical treatment and remain a challenge to doctors. Patient 2 A 63-year-old housewife with a 2-year history of dry cough was referred for the suspicious GERC She described that cough occurred through day and night, and disturbed her sleep, with the occasional heartburn, regurgitation and urinary incontinence (Table 1). When waiting for the results of the laboratory investigations, the patients was treated with antihistamine/ decongestant for a week, but without success No improvement in her cough and gastrointestinal symptoms was noted with 8 weeks course of initial antireflux medical treatment comprising omeprazole and domperidone. Patient 3 A 42 year-old man with a 2-year history of persistent dry cough was referred for the diagnosis of cause He coughed all the day, severely at postprandial time or when going to bed. No obvious adverse effect except for a slight sleepiness was reported during the treatment with baclofen

Discussion

13. Dicpinigaitis PV

Findings

Irwin RS: Chronic cough due to gastroesophageal reflux disease