title: Citric acid cough threshold in patients with gastroesophageal reflux disease rises after laparoscopic fundoplication.
abstract: BACKGROUND
  It has been reported that antireflux surgery can diminish chronic cough due to gastroesophageal reflux disease (GERD) that is resistant to pharmacologic therapy. The aim of this study was the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to GERD before and 3 months after laparoscopic Toupet fundoplication.
  
  
  METHODS
  Thirty subjects (20 women and 10 men; median age, 45.3 years) with chronic cough due to GERD and 15 healthy volunteers underwent cough challenge with doubling concentrations of citric acid. Twenty subjects with GERD, a group of 14 women and 6 men (mean age, 45.5 years), underwent the same protocol 3 months after laparoscopic fundoplication. Daytime and nighttime cough score questionnaires (verbal category descriptive score) were completed in all groups.
  
  
  RESULTS
  The geometric mean of CACT was significantly lower in GERD patients (9.62 mg/mL) than in healthy volunteers (50.8 mg/mL, p < 0.001). The results of cough score measurement significantly improved within 2 weeks after laparoscopic surgery. In 13 weeks of postoperative follow-up, cough disappeared or was greatly improved in 14 of the 20 patients (70%); in 3 other patients, cough resolved partially. In three patients. there was no improvement in cough. Cough challenge after surgery revealed a significant increase in mean cough threshold, from 8.28 to 19.03 mg/mL (p < 0.05).
  
  
  CONCLUSIONS
  The results suggest that GERD influences CACT, which was significantly lower in GERD patients compared to healthy subjects. A significant correlation was found between subjective and objective measurements of cough in GERD patients. We found laparoscopic fundoplication to be objectively beneficial in GERD-induced chronic cough, as it reduced the CACT.
authors.affiliation: Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Koziolka 1, Poland. ftpulmza@slam.katowice.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Ziora
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jarosz
authors.forename: Józef
authors.initials: J
authors.lastname: Dzielicki
authors.forename: Jacek
authors.initials: J
authors.lastname: Ciekalski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Krzywiecki
authors.forename: Szymon
authors.initials: S
authors.lastname: Dworniczak
authors.forename: Jerzy
authors.initials: J
authors.lastname: Kozielski
mesh_terms: D000328:Adult; D002908:Chronic Disease; D019343:Citric Acid; D003371:Cough / Q000139:chemically induced / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012684:Sensory Thresholds
chemical_list: D019343:Citric Acid