Document Detail

Cough threshold in reflux oesophagitis: influence of acid and of laryngeal and oesophageal damage.
MedLine Citation:
PMID:  10807885     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Gastro-oesophageal reflux is often associated with cough. Patients with reflux show an enhanced tussive response to bronchial irritants, even in the absence of respiratory symptoms. AIM: To investigate the effect of mucosal damage (either oesophageal or laryngeal) and of oesophageal acid flooding on cough threshold in reflux patients. PATIENTS: We studied 21 patients with reflux oesophagitis and digestive symptoms. Respiratory diseases, smoking, and use of drugs influencing cough were considered exclusion criteria. METHODS: Patients underwent pH monitoring, manometry, digestive endoscopy, laryngoscopy, and methacholine challenge. We evaluated the cough response to inhaled capsaicin (expressed as PD5, the dose producing five coughs) before therapy, after five days of omeprazole therapy, and when oesophageal and laryngeal damage had healed. RESULTS: In all patients spirometry and methacholine challenge were normal. Thirteen patients had posterior laryngitis and eight complained of coughing. Twenty patients showed an enhanced cough response (basal PD5 0.92 (0.47) nM; mean (SEM)) which improved after five and 60 days (2.87 (0.82) and 5.88 (0.85) nM; p<0.0001). The severity of oesophagitis did not influence PD5 variation. On the contrary, the response to treatment was significantly different in patients with and without laryngitis (p = 0.038). In patients with no laryngitis, the cough threshold improved after five days with no further change thereafter. In patients with laryngitis, the cough threshold improved after five days and improved further after 60 days. Proximal and distal oesophageal acid exposure did not influence PD5. Heartburn disappeared during the first five days but the decrease in cough and throat clearing were slower. CONCLUSIONS: Patients with reflux oesophagitis have a decreased cough threshold. This is related to both laryngeal inflammation and acid flooding of the oesophagus but not to the severity of oesophagitis. Omeprazole improves not only respiratory and gastro-oesophageal symptoms but also the cough threshold.
L Benini; M Ferrari; C Sembenini; M Olivieri; R Micciolo; V Zuccali; G M Bulighin; F Fiorino; A Ederle; V L Cascio; I Vantini
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gut     Volume:  46     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-08-01     Completed Date:  2000-08-01     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  762-7     Citation Subset:  AIM; IM    
Department of Gastroenterology, Rehabilitation Hospital at Valeggio sM, University of Verona, Verona, Italy.
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MeSH Terms
Bronchoconstrictor Agents / diagnostic use
Capsaicin / diagnostic use
Cough / etiology*
Esophagitis / etiology*
Esophagus / drug effects
Forced Expiratory Volume / physiology
Gastric Acid / physiology
Gastroesophageal Reflux / complications*
Laryngitis / etiology
Larynx / drug effects
Methacholine Chloride / diagnostic use
Reg. No./Substance:
0/Bronchoconstrictor Agents; 404-86-4/Capsaicin; 62-51-1/Methacholine Chloride

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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