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ANSWER: D
Critique
Cough is considered to be one of the atypical manifestations of reflux disease. The mechanisms include regurgitation with tracheal aspiration of gastric content, but also triggering of reflex bronchial reactivity with small amounts of acid in the distal esophagus in predisposed individuals. However, environmental allergens, postnasal drip, and airway disorders can also trigger chronic cough. Upper endoscopy with esophageal biopsies may demonstrate reflux esophagitis, but this does not establish whether cough is triggered by reflux events. A solid bolus barium swallow is useful in the evaluation of esophageal dysphagia. Impedance planimetry assesses biomechanical properties of the esophageal wall, and does not help assess the role of reflux in chronic cough. Esophageal high-resolution manometry will demonstrate esophageal motor patterns, but does not determine causality of chronic cough. Wireless pH testing off PPI therapy has the potential to determine whether cough events correlate with acidic reflux events. Some investigators have combined this with a cough monitor that can precisely time cough events, allowing for more accurate assessments of the association between cough and reflux events.
- Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 2005;54:449–54.
- Smith J, Woodcock A, Houghton L. New developments in reflux-associated cough. Lung 2010;188(Suppl1)S81-6.
- Sifrim D, Barnes N. GERD related chronic cough: How to identify patients who will respond to antireflux therapy. J. Clin. Gastroenterol. 2010;44:234-6.
ANSWER: D
Critique
Cough is considered to be one of the atypical manifestations of reflux disease. The mechanisms include regurgitation with tracheal aspiration of gastric content, but also triggering of reflex bronchial reactivity with small amounts of acid in the distal esophagus in predisposed individuals. However, environmental allergens, postnasal drip, and airway disorders can also trigger chronic cough. Upper endoscopy with esophageal biopsies may demonstrate reflux esophagitis, but this does not establish whether cough is triggered by reflux events. A solid bolus barium swallow is useful in the evaluation of esophageal dysphagia. Impedance planimetry assesses biomechanical properties of the esophageal wall, and does not help assess the role of reflux in chronic cough. Esophageal high-resolution manometry will demonstrate esophageal motor patterns, but does not determine causality of chronic cough. Wireless pH testing off PPI therapy has the potential to determine whether cough events correlate with acidic reflux events. Some investigators have combined this with a cough monitor that can precisely time cough events, allowing for more accurate assessments of the association between cough and reflux events.
ANSWER: D
Critique
Cough is considered to be one of the atypical manifestations of reflux disease. The mechanisms include regurgitation with tracheal aspiration of gastric content, but also triggering of reflex bronchial reactivity with small amounts of acid in the distal esophagus in predisposed individuals. However, environmental allergens, postnasal drip, and airway disorders can also trigger chronic cough. Upper endoscopy with esophageal biopsies may demonstrate reflux esophagitis, but this does not establish whether cough is triggered by reflux events. A solid bolus barium swallow is useful in the evaluation of esophageal dysphagia. Impedance planimetry assesses biomechanical properties of the esophageal wall, and does not help assess the role of reflux in chronic cough. Esophageal high-resolution manometry will demonstrate esophageal motor patterns, but does not determine causality of chronic cough. Wireless pH testing off PPI therapy has the potential to determine whether cough events correlate with acidic reflux events. Some investigators have combined this with a cough monitor that can precisely time cough events, allowing for more accurate assessments of the association between cough and reflux events.
- Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 2005;54:449–54.
- Smith J, Woodcock A, Houghton L. New developments in reflux-associated cough. Lung 2010;188(Suppl1)S81-6.
- Sifrim D, Barnes N. GERD related chronic cough: How to identify patients who will respond to antireflux therapy. J. Clin. Gastroenterol. 2010;44:234-6.
- Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut 2005;54:449–54.
- Smith J, Woodcock A, Houghton L. New developments in reflux-associated cough. Lung 2010;188(Suppl1)S81-6.
- Sifrim D, Barnes N. GERD related chronic cough: How to identify patients who will respond to antireflux therapy. J. Clin. Gastroenterol. 2010;44:234-6.