Effects of anti-reflux surgery on chronic cough and asthma in patients with gastro-oesophageal reflux disease.

This two-group prospective study evaluated the effect of anti-reflux surgery (fundoplication) on 24 patients with severe gastro-oesophageal reflux disease (GORD) and concomitant asthma (n=13) or chronic cough (n=11). Twenty-four hour oesophageal pH monitoring and lung function tests (FEV1, FVC) were done before and within 1 year after anti-reflux surgery. A diary was kept by the patient during the 4-week period prior to surgery and during 4-week periods 6 and 12 months postoperatively, with daily monitoring of peak expiratory flow rate, respiratory and reflux symptoms and medication. In non-asthmatic patients, coughing was reduced by 47% and 80% during the day and night, respectively, 12 months after surgery (P < 0.01). Concomitant hoarseness and expectoration were also significantly reduced (P<0.05). No effect on lung function was seen. In patients with asthma, small, non-significant reductions in asthma symptom scores and consumption of rescue medication were seen. Twenty-two patients were completely free from their GORD symptoms after surgery. In conclusion, anti-reflux surgery in patients with GORD had a more favourable effect on concomitant cough than concomitant asthma.

[1]  P. Pasquis,et al.  Surgical treatment of gastroesophageal reflux in ten patients with severe asthma. , 1989, Respiration; international review of thoracic diseases.

[2]  Mansfield Le,et al.  Gastroesophageal reflux and asthma: a possible reflex mechanism. , 1978, Annals of allergy.

[3]  J. Earis,et al.  Relationship between asthma and gastro-oesophageal reflux. , 1981, Thorax.

[4]  J. Kennedy.  “Silent” Gastroesophageal Reflux: An Important but Little Known Cause of Pulmonary Complications , 1962 .

[5]  M. Kaye,et al.  Antireflux treatment for asthma. Improvement in patients with associated gastroesophageal reflux. , 1987, Archives of internal medicine.

[6]  L. Tibbling,et al.  Oesophageal reflux tests, manometry, endoscopy, biopsy, and radiology in healthy subjects. , 1986, Scandinavian journal of gastroenterology.

[7]  A. Pack,et al.  Mechanisms for the association of gastroesophageal reflux and bronchospasm. , 1985, The American review of respiratory disease.

[8]  R. Overholt,et al.  Esophageal reflux as a trigger in asthma. , 1966, Diseases of the chest.

[9]  M. Pratter,et al.  An Algorithmic Approach to Chronic Cough , 1993, Annals of Internal Medicine.

[10]  E. Mays.  Intrinsic asthma in adults. Association with gastroesophageal reflux. , 1976, JAMA.

[11]  C. Pope,et al.  Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux. , 1991, Chest.

[12]  J. Richter,et al.  Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome. , 1996, The American journal of medicine.

[13]  B. Wranne,et al.  Oesophageal function in asthmatics. , 1981, European journal of respiratory diseases.

[14]  P. Adeleine,et al.  Long-term results of surgical treatment for gastroesophageal reflux in asthmatic patients. , 1989, Chest.

[15]  T. Ekström,et al.  Effects of ranitidine treatment on patients with asthma and a history of gastro-oesophageal reflux: a double blind crossover study. , 1989, Thorax.

[16]  G. Chejfec,et al.  Is gastroesophageal reflux a factor in some asthmatics? , 1987, The American journal of gastroenterology.

[17]  C. Pellegrini,et al.  Gastroesophageal reflux and pulmonary aspiration: incidence, functional abnormality, and results of surgical therapy. , 1979, Surgery.

[18]  Urschel Hc,et al.  Gastroesophageal reflux and hiatal hernia: complications and therapy. , 1979 .

[19]  R. Irwin,et al.  Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. , 1990, The American review of respiratory disease.

[20]  J H Peters,et al.  Outcome of respiratory symptoms after antireflux surgery on patients with gastroesophageal reflux disease. , 1996, Archives of surgery.

[21]  L. Tibbling,et al.  Is mis-swallowing or smoking a cause of respiratory symptoms in patients with gastroesophageal reflux disease? , 1995, Dysphagia.

[22]  M. Newhouse,et al.  Chronic cough and gastroesophageal reflux. , 1989, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.