Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough

M. Ribolsi, E. Savarino, N. De Bortoli, P. Balestrieri, M. Furnari, I. Martinucci, M. Casale, F. Greco, F. Salvinelli, V. Savarino, S. Marchi, M. Cicala

Research output: Contribution to journalArticle

Abstract

Background Gastro-oesophageal reflux disease (GERD) may contribute to the onset of chronic cough (CC); however, the multichannel intraluminal impedance-pH (MII-pH) monitoring is often within the normal range and the response to proton pump inhibitors (PPIs) unsatisfactory. The measure of impedance baseline (IB) increases the sensitivity of MII-pH in patients with typical symptoms.

Aim To evaluate the role of MII-pH variables, including IB, in predicting PPI response and to define the characteristics of the reflux pattern in CC patients. Methods Prospectively selected CC patients suspected GERD-related underwent MII-pH monitoring and, therefore, received a double dose of PPIs for at least 6 weeks. Patients filled symptom scores before MII-pH and after PPI therapy. MII-pH data were compared with those obtained in 60 non-erosive reflux disease patients with typical symptoms.

Results A total of 156 CC patients entered the study: 68 (43.5%) responders and 88 (56.5%) nonresponders to PPIs. The number of reflux episodes was significantly higher in CC compared with that in typical symptoms patients. Nonresponder CC patients with a pathological acid exposure time (AET) and/or IB value were 43/88 (49%), while 15/88 (17%) presented only pathological AET (P <0.001). CC patients with a pathological AET or IB, or with both a pathological AET and IB, showed a probability of PPI response twofold greater than patients with normal AET and IB. Conclusions The presence of a pathological AET or pathological IB in CC patients is associated with a greater probability of PPI response. IB is a promising variable in patients with CC, as it increases the diagnostic yield of MII-pH and allows confirmation of the GERD diagnosis in these patients.

Original languageEnglish
Pages (from-to)966-973
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume40
Issue number8
DOIs
Publication statusPublished - Oct 1 2014

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Medicine(all)

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    Ribolsi, M., Savarino, E., De Bortoli, N., Balestrieri, P., Furnari, M., Martinucci, I., Casale, M., Greco, F., Salvinelli, F., Savarino, V., Marchi, S., & Cicala, M. (2014). Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough. Alimentary Pharmacology and Therapeutics, 40(8), 966-973. https://doi.org/10.1111/apt.12919