title: Effectiveness of antireflux surgery for the cure of chronic cough associated with gastroesophageal reflux disease.
abstract: BACKGROUND
  The effectiveness of surgical therapy for chronic cough secondary to gastroesophageal reflux disease remains controversial. The purpose of this study was to assess the efficacy of surgery and to identify the preoperative clinical profile that could predict the positive effects of treatment on chronic cough.
  
  
  METHODS
  Of 299 patients who underwent antireflux surgery between 1995 and 2010, 67 patients were affected by chronic cough and typical symptoms. In addition, 83 patients with typical symptoms were selected to form the control group, according to the parameters of age, sex, and the period of surgical activity. Preoperatively, all patients underwent a workup, including symptom assessment, barium swallow, upper gastrointestinal endoscopy, esophageal manometry, and 24-h pH recording or intraluminal impedance/pH monitoring in the absence of esophagitis. Patients with chronic cough also were administered a high-resolution computed tomography scan of the chest, a methacholine challenge test, and spirometry. Surgery was performed on patients positive for gastroesophageal reflux disease and negative for pulmonary diseases. The patients were followed up for a median of 84 months after surgery.
  
  
  RESULTS
  No significant differences in preoperative reflux symptoms or esophagitis were found between the two groups. After surgery, chronic cough was absent in 57 (85 %) patients. Of the ten patients who still reported chronic cough, reflux symptoms relapsed in five, two of whom developed esophagitis. In the other five patients, typical symptoms were absent, and their chronic cough had improved but had not disappeared.
  
  
  CONCLUSIONS
  Surgery is effective for the treatment of chronic cough secondary to gastroesophageal reflux disease, particularly if associated with severe and long-standing typical symptoms.
authors.affiliation: Division of Thoracic Surgery, Center for the Study and Therapy of Diseases of the Esophagus, Alma Mater Studiorum - University of Bologna, Via G. Massarenti 9, 40138, Bologna, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Lugaresi
authors.forename: Beatrice
authors.initials: B
authors.lastname: Aramini
authors.forename: Niccolò
authors.initials: N
authors.lastname: Daddi
authors.forename: Fabio
authors.initials: F
authors.lastname: Baldi
authors.forename: Sandro
authors.initials: S
authors.lastname: Mattioli
mesh_terms: D000328:Adult; D000368:Aged; D003371:Cough / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged