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Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough

BACKGROUND: Not all gastroesophageal reflux-induced cough (GERC) patients respond to anti-reflux treatment. It is not certain whether reflux-related symptoms or other clinical characteristics could indicate a successful response to anti-reflux treatment. In this study, we aimed to investigate the re...

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Autores principales: Xu, Tingting, Yang, Ye, Zhan, Wenzhi, Lin, Mingtong, Ding, Wenbin, Chen, Zhiyin, Li, Yuling, Xu, Dongting, Lai, Kefang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10183552/
https://www.ncbi.nlm.nih.gov/pubmed/37197530
http://dx.doi.org/10.21037/jtd-22-1046
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author Xu, Tingting
Yang, Ye
Zhan, Wenzhi
Lin, Mingtong
Ding, Wenbin
Chen, Zhiyin
Li, Yuling
Xu, Dongting
Lai, Kefang
author_facet Xu, Tingting
Yang, Ye
Zhan, Wenzhi
Lin, Mingtong
Ding, Wenbin
Chen, Zhiyin
Li, Yuling
Xu, Dongting
Lai, Kefang
author_sort Xu, Tingting
collection PubMed
description BACKGROUND: Not all gastroesophageal reflux-induced cough (GERC) patients respond to anti-reflux treatment. It is not certain whether reflux-related symptoms or other clinical characteristics could indicate a successful response to anti-reflux treatment. In this study, we aimed to investigate the relationship between clinical features and anti-reflux response. METHODS: We retrospectively analyzed the clinical characteristics of suspected GERC who had reflux-related symptoms or reflux evidence based on abnormal 24-hour esophageal pH value monitoring, or who had no evidence of other common causes of chronic cough in our chronic cough database with a standard case report form. All patients experienced anti-reflux treatment with proton pump inhibitors (PPIs) plus prokinetic agents for at least 2 weeks and were divided into responders and non-responders based on the treatment response. RESULTS: Among 241 patients with suspected GERC, 146 (60.6%) showed a successful response. There was no significant difference in regard to the proportion of reflux-related symptoms, and results of 24-hour esophageal pH value monitoring between responders and non-responders. Compared with non-responders, responders had higher proportions of nasal itching (21.2% vs. 8.4%; P=0.014), tickle in the throat (51.4% vs. 35.8%; P=0.025) and lower proportion of pharyngeal foreign body sensation (32.9% vs. 54.7%; P=0.001). Multivariate analysis showed that nasal itching [hazard ratio (HR): 1.593, 95% confidence interval (CI): 1.025–2.476, P=0.039], tickle in the throat (HR: 1.605, 95% CI: 1.152–2.238, P=0.005), pharyngeal foreign body sensation (HR: 0.499, 95% CI: 0.346–0.720, P<0.001) and sensitivity to at least one cough trigger (HR: 0.480, 95% CI: 0.237–0.973, P=0.042) were associated with the therapeutic response. CONCLUSIONS: Over half of suspected GERC patients benefited from anti-reflux therapy. A few clinical features rather than reflux-related symptoms might indicate a response to anti-reflux treatment. Further study is needed for the predictive value.
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spelling pubmed-101835522023-05-16 Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough Xu, Tingting Yang, Ye Zhan, Wenzhi Lin, Mingtong Ding, Wenbin Chen, Zhiyin Li, Yuling Xu, Dongting Lai, Kefang J Thorac Dis Original Article on Novel Insights into Chronic Cough BACKGROUND: Not all gastroesophageal reflux-induced cough (GERC) patients respond to anti-reflux treatment. It is not certain whether reflux-related symptoms or other clinical characteristics could indicate a successful response to anti-reflux treatment. In this study, we aimed to investigate the relationship between clinical features and anti-reflux response. METHODS: We retrospectively analyzed the clinical characteristics of suspected GERC who had reflux-related symptoms or reflux evidence based on abnormal 24-hour esophageal pH value monitoring, or who had no evidence of other common causes of chronic cough in our chronic cough database with a standard case report form. All patients experienced anti-reflux treatment with proton pump inhibitors (PPIs) plus prokinetic agents for at least 2 weeks and were divided into responders and non-responders based on the treatment response. RESULTS: Among 241 patients with suspected GERC, 146 (60.6%) showed a successful response. There was no significant difference in regard to the proportion of reflux-related symptoms, and results of 24-hour esophageal pH value monitoring between responders and non-responders. Compared with non-responders, responders had higher proportions of nasal itching (21.2% vs. 8.4%; P=0.014), tickle in the throat (51.4% vs. 35.8%; P=0.025) and lower proportion of pharyngeal foreign body sensation (32.9% vs. 54.7%; P=0.001). Multivariate analysis showed that nasal itching [hazard ratio (HR): 1.593, 95% confidence interval (CI): 1.025–2.476, P=0.039], tickle in the throat (HR: 1.605, 95% CI: 1.152–2.238, P=0.005), pharyngeal foreign body sensation (HR: 0.499, 95% CI: 0.346–0.720, P<0.001) and sensitivity to at least one cough trigger (HR: 0.480, 95% CI: 0.237–0.973, P=0.042) were associated with the therapeutic response. CONCLUSIONS: Over half of suspected GERC patients benefited from anti-reflux therapy. A few clinical features rather than reflux-related symptoms might indicate a response to anti-reflux treatment. Further study is needed for the predictive value. AME Publishing Company 2023-04-23 2023-04-28 /pmc/articles/PMC10183552/ /pubmed/37197530 http://dx.doi.org/10.21037/jtd-22-1046 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article on Novel Insights into Chronic Cough
Xu, Tingting
Yang, Ye
Zhan, Wenzhi
Lin, Mingtong
Ding, Wenbin
Chen, Zhiyin
Li, Yuling
Xu, Dongting
Lai, Kefang
Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
title Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
title_full Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
title_fullStr Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
title_full_unstemmed Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
title_short Predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
title_sort predictive value of clinical features for anti-reflux therapy response in suspected gastroesophageal reflux-induced chronic cough
topic Original Article on Novel Insights into Chronic Cough
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10183552/
https://www.ncbi.nlm.nih.gov/pubmed/37197530
http://dx.doi.org/10.21037/jtd-22-1046
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