Chronic cough: a gastroenterology perspective

Abstract

Purpose of review: The purpose of this review is to highlight recent work and provide recommendations on the approach for diagnosis and management of chronic cough in a gastroenterology clinic.

Recent findings: Chronic cough is a burdensome symptom affecting a large number of patients and contributes significant cost to the healthcare system. Recent work has shown that select patients may benefit from acid-suppressive therapy and even surgery when there is true pathologic evidence of reflux disease with cough. However, judicious use and proper interpretation of diagnostic testing for gastroesophageal reflux in the setting of cough is important to avoid unnecessary or inappropriate therapy.

Summary: Chronic cough remains a vexing problem for many physicians, including gastroenterologists. It is important that physicians approach refractory cough in a multidisciplinary manner. Future research is needed to better understand the likely central hypersensitivity response mediating reflux-related cough and potential alternative approaches to therapy.

Figure 1

Diagnostic algorithm for chronic cough attributed to gastroesophageal reflux disease

Figure 2

Overall average and range of therapeutic gain in cough patients treated with PPI therapy based on datasets from 9 studies (Reproduced with permission from [12])