Acid regurgitation associated with persistent cough after pulmonary resection: an observational study

BACKGROUND: Following a pulmonary resection, some patients suffer from persistent coughing, which may have a relationship with acid regurgitation. Since few physiological studies have been reported regarding this issue, we conducted the present observational study. METHODS: Persistent cough after pulmonary resection (CAP) was defined as non-productive coughing that occurred after a pulmonary resection in patients with stable chest X-ray results and no postnasal drip syndrome, asthma, or history of angiotensin converting enzyme inhibitor administration. A 24-hour esophageal pH monitor was used with patients with coughing (n = 13) and patients with no coughing (n = 4) after undergoing a lobectomy, and the relationship between acid regurgitation and CAP was assessed using symptom association probability. RESULTS: Based on the results of pH monitoring conducted within 4 weeks of the operation we divided the patients into 3 groups: Type A had frequent gastroesophageal refluxes (>50 occurrences in 24 hours) and frequent coughing (>30 occurrences in 24 hours), Type B had frequent gastroesophageal refluxes and infrequent coughing, and type C had infrequent gastroesophageal refluxes and infrequent coughing. Type A patients (n = 10) were exclusively those with CAP and the symptom association probability was greater than 95%. Five from that group underwent esophageal pH monitoring more than 1 year after surgery and none showed significant improvements in acid regurgitation. CONCLUSION: There was a relationship seen between acid regurgitation and CAP in some patients shortly after surgery, while acid regurgitation remained unimproved after improvement of coughing in most of those 1 year after surgery.