Pulmonary symptoms associated with gastroesophageal reflux: use of ambulatory pH monitoring to diagnose and to direct therapy.
BACKGROUND
We studied 54 patients with chronic persistent cough or asthma suspected to be due to reflux using distal and proximal pH monitoring. Therapy for reflux was determined by the referring physician and included H2 blockers (51%), omeprazole (36%), surgery (10%), and lifestyle modifications only (3%). On follow-up evaluation, the effect of anti-reflux therapy on pulmonary symptoms (PS) was scored as excellent, good, fair, no change, or worsening symptoms.


RESULTS
Forty-two of the 54 patients (78%) had abnormal reflux. Of these, 28 patients (67%) had abnormal proximal acid exposure. Seventy-one percent of reflux patients achieved good to excellent response in PS from anti-reflux therapy. The response was not significantly different between patients with proximal reflux and those with only distal reflux. None of the patients without documented reflux who nevertheless received anti-reflux therapy had a response, even when fair improvement was included as a response. Seventeen percent of patients whose pulmonary symptoms responded to anti-reflux therapy would not have been recognized as having abnormal reflux if proximal pH monitoring had not been done.


CONCLUSIONS
The percentage of patients (78%) with pulmonary symptoms having abnormal reflux is consistent with prior studies. Documenting abnormal gastroesophageal reflux helps direct appropriate therapy, and proximal pH monitoring may identify patients with pulmonary symptoms who respond to anti-reflux therapy.
Schnatz
P F
PF
Graduate Hospital, Philadelphia, Pennsylvania, USA.
Castell
J A
JA
Castell
D O
DO
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology* / Q000517:prevention & control; D003371:Cough / Q000209:etiology* / Q000517:prevention & control; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009853:Omeprazole / Q000627:therapeutic use; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D009853:Omeprazole