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World J Methodol. Sep 26, 2015; 5(3): 149-156
Published online Sep 26, 2015. doi: 10.5662/wjm.v5.i3.149
Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management
Han-Jing Lv, Zhong-Min Qiu
Han-Jing Lv, Zhong-Min Qiu, Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
Author contributions: Both authors contributed to this manuscript.
Supported by The National Natural Science Foundation of China, Nos. 81170079 and 81470276; and Shanghai Shenkang Hospital Development Center, No. SHDC12012211.
Conflict-of-interest statement: None of the authors has a conflict of interest to declare in relation to this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Zhong-Min Qiu, Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai 200065, China. qiuzhongmin@tongji.edu.cn
Telephone: +86-21-66111286 Fax: +86-21-56050502
Received: April 2, 2015
Peer-review started: April 2, 2015
First decision: June 3, 2015
Revised: July 6, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: September 26, 2015
Abstract

Refractory chronic cough due to gastroesophageal reflux is a troublesome condition unresponsive to the standard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.

Keywords: Esophageal pH monitoring; Chronic cough; Anti-reflux therapy; Refractory cough; Gastroesophageal reflux

Core tip: Refractory cough due to reflux can be defined as a reflux-induced cough resistant to standard medical anti-reflux treatment but responsive to the subsequent intensified anti-reflux therapy. It may be associated with the residual acid or non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The definite diagnosis of the disorder depends on the positive findings of multi-channel intraluminal impedance-pH monitoring as well as favorable response to the intensified anti-reflux therapy. The current therapeutic strategies include the complete acid suppression and add-on uses of baclofen or gabapentin.