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Reflux pattern and role of impedance‐pH variables in predicting PPI response in patients with suspected GERD‐related chronic cough
Author(s) -
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.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12919
Subject(s) - reflux , medicine , gerd , pathological , gastroenterology , proton pump inhibitor , chronic cough , disease , asthma
Summary 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 PPI s. 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.