Analysis of the effectiveness of anti-reflux surgery for chronic cough combined with gastroesophageal reflux disease and/or hiatal hernia

doi:10.3877/cma.j.issn.2095-8765.2021.01.002

Abstract

Abstract:

Obstract　chronic cough is one of the common extra-esophageal symptom of gastroesophageal reflux disease, and possess a variety of etiologies, among the etiologies of chronic cough, respiratory disease is the most common one, followed by gastroesophageal reflux. For chronic cough that may be caused by gastroesophageal reflux, anti-reflux treatment is needed. While laparoscopic fundoplication can solve 90% of regurgitation and/or heartburn, its effectiveness for chronic cough that may be caused by gastroesophageal reflux is variable. The aim of this study was to investigate the overall effectiveness of anti-reflux surgery for chronic cough in patients with gastroesophageal reflux disease and/or hiatal hernia in our center, and explore its related predictive factors.

Methods

the overall effectiveness of anti-reflux surgery for chronic cough was determined through telephone interview, and the predictive factors was determined through Logistic regression analysis.

Results

information from 230 patients was included for analysis in total. All of them had chronic cough before operation, among which 152 (66.1%) were cured, 30 (13.0%) were significantly improved. At the multivariate level (cured +excellent vs fair +poor), regurgitation was an independent predict factors for the effectiveness of anti-reflux surgery (OR=3.326, 95% CI=1.483-7.462, P=0.004).

Conclusions

anti-reflux surgery is highly effective for chronic cough in patients with GERD or HH, and regurgitation is an independent predictive factor. However, objective evidence of GERD or HH (either isolate or combined) seems to be irrelevant to the improvement of chronic cough. Further prospective studies should focus on the role of PPI response for chronic cough, postural cough, regurgitation induced cough and reflux-cough correlation based on objective recorded cough.

Key words: gastroesophageal reflux disease, cough, esophagitis, hiatal hernia, fundoplication

Dong Chen, Fei Xiao, Zhiwei Hu, Jimin Wu. Analysis of the effectiveness of anti-reflux surgery for chronic cough combined with gastroesophageal reflux disease and/or hiatal hernia[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2021, 08(01): 9-15.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwsgflbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8765.2021.01.002

https://zhwsgflbdzzz.cma-cmc.com.cn/EN/Y2021/V08/I01/9

Figures/Tables 6

References 30

1	Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease [J]. American Journal of Gastroenterology, 2013, 108(3):308-328.
2	Kahrilas PJ, Howden CW, Hughes N, et al. Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease [J]. Chest, 2013, 143(3):605-612.
3	Lai K, Pan J, Chen R, et al. Epidemiology of cough in relation to China [J]. Cough (London, England), 2013, 9(1):18.
4	Lai K, Chen R, Lin J, et al. A prospective, multicenter survey on causes of chronic cough in China [J]. Chest, 2013, 143(3):613-620.
5	Kahrilas PJ, Altman KW, Chang AB, et al. Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report [J]. Chest, 2016, 150(6):1341-1360.
6	Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines [J]. Chest, 2006, 129(1 Suppl): 80s-94s.
7	Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification [J]. Gut, 1999, 45(2):172.
8	Hyun JJ, Kim JH, Yeon JE, et al. Short segment hiatal hernia: is it a clinically significant entity? [J]. Journal of neurogastroenterology and motility, 2010, 16(1):35-39.
9	Wiener GJ, Richter JE, Copper JB, et al. The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring [J]. The American journal of gastroenterology, 1988, 83(4):358-361.
10	Weusten BL, Roelofs JM, Akkermans LM, et al. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data [J]. Gastroenterology, 1994, 107(6):1741-1745.
11	Roman S, Gyawali CP, Savarino E, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group [J]. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2017, 29(10):1-15.
12	Liang WT, Yan C, Wang ZG, et al. Early and Midterm Outcome After Laparoscopic Fundoplication and a Minimally Invasive Endoscopic Procedure in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study [J]. Journal of laparoendoscopic & advanced surgical techniques Part A, 2015, 25(8):657-661.
13	Chen D, Wang ZG, Hu ZW, et al. Typical symptoms and not positive reflux-cough correlation predict cure of gastroesophageal reflux disease related chronic cough after laparoscopic fundoplication: a retrospective study [J]. BMC Gastroenterology, 2019, 19(1):108.
14	Morgenthal CB, Lin E, Shane MD, et al. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes [J]. Surgical endoscopy, 2007, 21(11):1978-1984.
15	Patti MG, Arcerito M, Tamburini A ,et al. Effect of laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms [J]. Journal of Gastrointestinal Surgery, 2000, 4(2):143-149.
16	Kaufman JA, Houghland JE, Quiroga E, et al. Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder [J]. Surgical Endoscopy & Other Interventional Techniques, 2006, 20(12):1824-1830.
17	Granderath FA, Kamolz T, Schweiger UM, et al. Quality of life and symptomatic outcome three to five years after laparoscopic Toupet fundoplication in gastroesophageal reflux disease patients with impaired esophageal motility [J]. American journal of surgery, 2002, 183(2):110-116.
18	Dallemagne B, Weerts J, Markiewicz S, et al. Clinical results of laparoscopic fundoplication at ten years after surgery [J]. Surgical endoscopy, 2006, 20(1):159-165.
19	Brillantino A, Schettino M, Torelli F, et al. Laparoscopic Nissen-Rossetti fundoplication is a safe and effective treatment for both Acid and bile gastroesophageal reflux in patients poorly responsive to proton pump inhibitor [J]. Surgical innovation, 2011, 18(4):387-393.
20	Iqbal M, Batch AJ, Spychal RT, et al. Outcome of surgical fundoplication for extraesophageal (atypical) manifestations of gastroesophageal reflux disease in adults: a systematic review. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 2008, 18(6):789.
21	Naik Rishi D, Vaezi Michael F. Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay [J]. Expert review of gastroenterology & hepatology, 2015, 9(7):969-982.
22	Houghton LA, Lee AS, Badri H, et al. Respiratory disease and the oesophagus: reflux, reflexes and microaspiration [J]. Nature reviews Gastroenterology & hepatology, 2016, 13(8):445-460.
23	Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus [J]. The American journal of gastroenterology, 2006, 101(8):1900-1920; quiz 1943.
24	Fock KM, Talley N, Goh KL, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus [J]. Gut, 2016, 65(9):1402-1415.
25	田书瑞,胡志伟,吴继敏,等. 胃食管阀瓣分级与胃食管反流病的相关性 [J]. 中华消化杂志, 2019, 39(4):257-260.
26	Chen D, Tian SR, Hu ZW, et al. Cardia Laxity under Retroflexed Endoscopy Is a Reflection of Esophageal Hiatus Enlargement [J]. Gastroenterology Research and Practice, 2020, 2020:9180167.
27	Herregods TVK, Pauwels A, Jafari J, et al. Ambulatory pH-impedance-pressure monitoring as a diagnostic tool for the reflux-cough syndrome [J]. Dis Esophagus, 2018, 31(1):1-7.
28	Herregods TVK, Pauwels A, Tack J, et al. Reflux-cough syndrome: Assessment of temporal association between reflux episodes and cough bursts [J]. Neurogastroenterol Motil, 2017, 29(12).
29	Herregods TVK, Pauwels A, Jafari J, et al. Determinants of reflux-induced chronic cough [J]. Gut, 2017, 66(12):2057-2062.
30	Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring [J]. Gut, 2005, 54(4):449-454.

中位数年龄（岁）	59（49~66）
男性［n（%）］	122（53.0%）
身体质量指数（kg/cm2）
偏轻（＜18.5）	5（2.2%）
正常（18.5~24.99）	119（51.7%）
超重（25~29.99）	101（43.9%）
肥胖（≥30）	5（2.2%）
高血压［n（%）］	72（31.3%）
糖尿病［n（%）］	11（4.8%）
冠心病［n（%）］	11（4.8%）

中位数年龄（岁）	59（49~66）
男性［n（%）］	122（53.0%）
身体质量指数（kg/cm2）
偏轻（＜18.5）	5（2.2%）
正常（18.5~24.99）	119（51.7%）
超重（25~29.99）	101（43.9%）
肥胖（≥30）	5（2.2%）
高血压［n（%）］	72（31.3%）
糖尿病［n（%）］	11（4.8%）
冠心病［n（%）］	11（4.8%）

症状	例数	治愈	显效	一般	无效
慢性咳嗽	230	152（66.1%）	30（13.0%）	14（6.1%）	34（14.8%）
烧心	162	133（82.1%）	14（8.6%）	6（3.7%）	9（5.6%）
反流	176	145（82.4%）	16（9.1%）	5（2.8%）	10（5.7%）
哮喘样症状	61	33（54.1%）	9（14.8%）	10（16.4%）	9（14.8%）
嗳气	33	24（72.7%）	2（6.1%）	1（3.0%）	6（18.2%）
胸背痛	21	17（81.0%）	2（9.5%）	1（4.8%）	1（4.8%）

症状	例数	治愈	显效	一般	无效
慢性咳嗽	230	152（66.1%）	30（13.0%）	14（6.1%）	34（14.8%）
烧心	162	133（82.1%）	14（8.6%）	6（3.7%）	9（5.6%）
反流	176	145（82.4%）	16（9.1%）	5（2.8%）	10（5.7%）
哮喘样症状	61	33（54.1%）	9（14.8%）	10（16.4%）	9（14.8%）
嗳气	33	24（72.7%）	2（6.1%）	1（3.0%）	6（18.2%）
胸背痛	21	17（81.0%）	2（9.5%）	1（4.8%）	1（4.8%）

变量	例数	结果		P值
变量	例数	治愈+显效	一般+无效	P值
烧心	230			＞0.05
有		131（80.9%）	31（19.1%）
无		51（75.0%）	17（25.0%）
反流	230			＜0.05
有		148（84.1%）	28（15.9%）
无		34（63.0%）	20（30.7%）
典型症状	230			＜0.05
有		159（82.0%）	35（18.0%）
无		23（63.9%）	13（36.1%）
嗳气	230			＞0.05
有		26（78.8%）	7（21.2%）
无		156（79.2%）	41（20.8%）
哮喘样症状	230			＞0.05
有		47（77.0%）	14（23.0%）
无		135（79.9%）	34（20.1%）
胸背痛	230			＞0.05
有		18（85.7%）	3（14.3%）
无		164（78.5%）	45（21.5%）
HH	230			＞0.05
有		152（78.4%）	42（21.6%）
无		30（83.3%）	6（16.7%）
食管炎	230			＞0.05
有		97（77.0%）	29（23.0%）
无		85（81.7%）	19（18.3%）
无效食管动力	195			＞0.05
＞50%		46（76.7%）	14（23.3%）
≤50%		106（78.5%）	29（21.5%）
总的酸暴露时间百分比	172			＞0.05
＞4.5%		69（75.8%）	22（24.2%）
≤4.5%		64（79.0%）	17（21.0%）
DeMeester积分	172			＞0.05
＞14.7		68（73.1%）	25（26.9%）
≤14.7		65（82.3%）	14（17.7%）
反流总次数（阻抗）	160			＞0.05
＞73		41（78.8%）	11（21.2%）
≤73		81（75.0%）	27（25.0%）
慢性咳嗽症状指数	101			＞0.05
＞50%		23（74.2%）	8（25.8%）
≤50%		52（74.3%）	18（25.7%）
慢性咳嗽症状相关概率	101			＞0.05
＞95%		38（74.5%）	13（25.5%）
≤95%		37（74.0%）	13（26.0%）
反流-咳嗽相关性	101			＞0.05
阳性		41（71.9%）	16（28.1%）
阴性		34（77.3%）	10（22.7%）

Please choose a citation manager

Content to export