Chronic cough and gastroesophageal reflux disease: experience with specific therapy for diagnosis and treatment

Chest. 2003 Mar;123(3):679-84. doi: 10.1378/chest.123.3.679.


Study objective: To evaluate experience using a therapeutic trial of proton-pump inhibitor therapy with or without a prokinetic agent in diagnosis and treatment of gastroesophageal reflux disease (GERD)-related cough.

Design: A review of experience with 214 patients with cough of > or = 3 weeks referred over 3.5 years. An anatomic diagnostic protocol was used to identify and treat those with GERD-related cough.

Setting: A pulmonary specialty practice affiliated with the University of Rochester School of Medicine and Dentistry.

Patients: One hundred eighty-three patients were identified with chronic cough and were included in the study. Thirty-one patients were disqualified because of abnormal chest radiographic findings, inadequate follow-up, or cough being not the primary complaint. Fifty-six patients were identified as having GERD-related cough.

Interventions: A once-daily dose of a proton-pump inhibitor was prescribed. A prokinetic agent was added if esophageal dysfunction was suspected or response was inadequate. Those who did not respond underwent 24-h esophageal pH monitoring.

Results: GERD was the single cause of cough in 24 patients (43%). Twenty-nine patients (52%) had GERD plus another cause, and 3 patients (5%) had GERD with more than two causes. Twenty-four patients (43%) had cough only, while 32 patients (57%) had other symptoms of GERD. Proton-pump therapy was successful in 42 patients (79%). Twenty-four patients responded to proton-pump inhibitor therapy, and 18 patients responded when metoclopramide or cisapride was added. The remaining two patients responded to a histamine type-2 blocker or cisapride alone. The cough was eliminated or markedly improved in 38 patients (86%) after 4 weeks and by 8 weeks in the remaining 6 patients. Six of the nonresponders had aspiration diagnosed by bronchoscopy. Four patients had fundoplication recommended, and two patients responded to alternative interventions.

Conclusions: Four to 6 weeks of a proton-pump inhibitor alone or in combination with a prokinetic agent successfully diagnoses and treats four of five patients with GERD-related cough. Twenty-four-hour esophageal pH monitoring will confirm the diagnosis in the others. These patients may be candidates for fundoplication. Nonresponders often aspirate as an additional aggravating factor.

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Cisapride / therapeutic use
  • Cough / diagnosis*
  • Cough / drug therapy*
  • Cough / etiology
  • Diagnostic Techniques, Digestive System
  • Drug Therapy, Combination
  • Enzyme Inhibitors / therapeutic use
  • Female
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / drug therapy*
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Hydrogen-Ion Concentration
  • Lansoprazole
  • Male
  • Metoclopramide / therapeutic use
  • Middle Aged
  • Omeprazole / analogs & derivatives
  • Omeprazole / therapeutic use
  • Proton Pump Inhibitors*
  • Retrospective Studies
  • Treatment Outcome


  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Enzyme Inhibitors
  • Gastrointestinal Agents
  • Proton Pump Inhibitors
  • Lansoprazole
  • Omeprazole
  • Metoclopramide
  • Cisapride