Long-term therapeutic outcome of patients undergoing ambulatory pH monitoring for chronic unexplained cough.
OBJECTIVE
Ambulatory pH monitoring is frequently performed to determine temporal associations between reflux events and chronic unexplained cough. We further explored the clinical value of ambulatory pH monitoring in predicting long-term symptomatic outcome of therapy in chronic cough.


METHODS
Symptom scores and reflux indicators from ambulatory pH study [acid exposure time, symptom association probability (SAP), and symptom index] were extracted from records of subjects undergoing esophageal evaluation for chronic cough. Intensity of antireflux therapy administered and symptomatic outcome were determined by telephone interview. Univariate and logistic regression analysis were performed to identify predictors of a high degree response (HDR), defined as sustained, durable symptom improvement lasting >3 months.


RESULTS
Fifty-three subjects (mean age 63+/-2 y, 42 females) fulfilled the inclusion criteria. Reflux parameters were abnormal on ambulatory pH monitoring in 54.7%. After a mean interval of 3+/-0.3 years, cough intensity improved significantly, 19 subjects (35.8%) achieving HDR. Only female sex and positive SAP predicted HDR on univariate analysis; SAP and intensity of antireflux therapy were retained as independent predictors (P<or=0.03) on logistic regression analysis. Sequential use of acid exposure time, SAP, and symptom index had the best value, with the highest likelihood of HDR when all three were positive (85.7%, P<0.01).


CONCLUSIONS
Reflux disease is a frequent cause of chronic unexplained cough and aggressive antireflux therapy forms a vital component of management. Positive SAP is an independent predictor of outcome, but hierarchical or sequential use of abnormal gastroesophageal reflux disease parameters on ambulatory pH testing has value in predicting long-term symptomatic response.
Hersh
Michael J
MJ
Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Sayuk
Gregory S
GS
Gyawali
C Prakash
CP
D000368:Aged; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011336:Probability; D054328:Proton Pump Inhibitors; D013997:Time Factors; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors