Abstract

To determine the frequency of the cough due to gastroesophageal reflux (GER), 2) to assess the role of 24-hour pH monitoring in the diagnosis of GER-induced cough, 3) to investigate the role of Capsaicin test in the assessment of efficacy of the therapy.

Totally 80 patients included. The patients with reflux symptom (n=22) have undergone both proximal and distal esophageal 24-hour pH monitoring and omeprazol was given. Before and after treatment, capsaicin test was performed to evaluate objectively cough response to inhaled capsaicin. Cough threshold was described as the lowest capsaicin concentration inducing 5 or more cough.

Following diagnoses were established in 80 patients: Postnasal drip syndrome in 21 (26%), GER-induced cough in 20 (25%), cough due to ACE inhibitor in 20 (25%), cough variant asthma in 17(21%), idiopathic cough in 2 patients.

pH monitoring revealed a pathologic GER in 12 (55%) and nonpathologic reflux in 10 patients (45%). pH monitoring showed reflux events in both proximal and distal probes in 6 of 12 patients, in only distal probe in 4 and in only proximal probe in 2 patients. There was a significant difference between the GER related cough thresholds before and after therapy (p= 0.002 and p=0.018, respectively).

In conclusion, (1) GER has an important role in the etiology of chronic nonproductive cough, (2) GER-induced cough cannot be ruled out in the absence of pathologic reflux symptoms in pH monitorization, (3) an empiric omeprazole therapy should be given to patients with reflux symptoms, without applying 24 hour pH monitoring, (4) capsaicin test is an objective and useful test for approach to cough and in the evaluation of efficacy of therapy.