CHEST Guidelines-Chronic-Cough-Due-to-Gastroesophageal-Reflux-in-Ad

Chronic-Cough-Due-to-Gastroesophageal-Reflux-in-Ad

Pdf Summary

The CHEST Guideline and Expert Panel Report on chronic cough due to gastroesophageal reflux disease (GERD) in adults provides updated recommendations based on a systematic review conducted to address specific questions regarding reflux-cough syndrome management. The primary focus was whether gastroesophageal reflux therapy could improve or eliminate chronic cough in adults and if there are clinical criteria to guide therapy choice.<br /><br />Key findings concluded that lifestyle modifications like weight loss and bed elevation might benefit those with suspected reflux-cough syndrome. However, Proton Pump Inhibitors (PPIs) demonstrated no additional benefit when used alone without lifestyle changes. The report highlighted that existing studies are low quality and demonstrate a strong placebo effect, with one study showing significant cough improvement from PPI therapy but lacking consistent results across other trials.<br /><br />For identifying patients for GERD-related cough treatment, the panel found that there are no specific clinical criteria that reliably predict treatment success. Observational studies suggest an algorithmic approach might help resolve chronic cough causes in a majority of cases, noting cough variant asthma and upper airway cough syndrome as common contributors.<br /><br />The panel recommends using a diagnostic/therapeutic algorithm focused on sequentially addressing common cough causes like asthma and UACS, before considering GERD-specific therapies. For patients whose cough remains unresolved after these non-GERD interventions, more detailed testing such as esophageal manometry and pH-metry is advised prior to surgical consideration.<br /><br />Ultimately, the panel stresses that management should involve a comprehensive assessment considering multiple factors, as chronic cough is often multifactorial. Future research is encouraged to address gaps, especially exploring the diagnostic value of reflux detection methods and potential treatment roles for lifestyle interventions and prokinetic agents.

Keywords

chronic cough

GERD

gastroesophageal reflux

reflux-cough syndrome

lifestyle modifications

Proton Pump Inhibitors

diagnostic algorithm

cough variant asthma

upper airway cough syndrome

esophageal manometry