Most with cough, throat clearing don't have GERD

Last Updated: 2015-08-04

By Anne Harding

NEW YORK (Reuters Health) - Patients with cough or throat clearing are not likely to have gastroesophageal reflux disease (GERD), according to new findings.

Based on the findings, patients with these atypical symptoms should undergo impedance-pH testing, rather than a trial of proton pump inhibitors (PPIs), Dr. Mustafa Abdul-Hussein, of the Medical University of South Carolina in Charleston, the new study's first author, told Reuters Health. "I prefer that we test the patient before we start the therapy, because you don't want to waste therapy 75% of the time," he said in a telephone interview.

Cough and throat clearing are the most common atypical symptoms of GERD, Dr. Abdul-Hussein and his team noted, and patients may have these symptoms without the classic "typical" symptoms of heartburn and regurgitation. Usually, the researchers added, these patients undergo a trial of PPI, and then have 24-hour ambulatory reflux monitoring if they fail PPI treatment.

To better understand how frequently cough and throat clearing occur in patients evaluated for GERD and the association of these atypical symptoms with a positive symptom index (SI) for reflux, the investigators reviewed impedance-pH studies for 267 patients referred to their clinic.

Forty-two percent had both throat clearing and cough, 28% had cough without throat clearing, and 30% had throat clearing without cough, the researchers reported in an article online July 18 in the Journal of Clinical Gastroenterology.

Among the patients with both cough and throat clearing, just 8% had a positive SI for GERD, compared to 26% of patients with cough alone and 22% of patients with throat clearing only. Patients with "excessive" cough, meaning more than 24 events per day, were less likely to have a positive SI than those with fewer events.

"All of the above need to be sorted out first," Dr. Abdul-Hussein said. "The positive side of testing is trying to give the patient an answer, whether this is really related (to GERD) or not, and not to waste therapy."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1HnW3Hh

J Clin Gastroenterol 2015.