Proximal acid reflux treated by fundoplication predicts a good outcome for chronic cough attributable to gastro-oesophageal reflux disease

The aim for this study is to examine whether proximal, as opposed to distal, oesophageal reflux predicts a good outcome after fundoplication in patients with suspected acid-induced chronic cough. Between 1999 and 2007, 81 patients with refractory chronic cough underwent manometry and dual-probe pH studies. In 59 patients, pathological reflux was confirmed, and 21 of these underwent laparoscopic fundoplication by a single surgeon. Proximal reflux was defined as an upper channel time pH < 4 of > 1.4%. The Chi-square test and Mann-Whitney U test were used in the statistical analysis. All patients with heartburn had their symptoms abolished by surgery. The proximal extent of reflux predicted cough improvement. Eleven of 14 patients with proven proximal reflux had complete symptom relief from surgery as opposed to two of seven with distal only reflux (Chi-square = 4.95; degrees of freedom = 1; p = 0.026). There was no correlation between oesophageal motility (as assessed by per cent abnormal wet swallows) and pathological reflux on outcome of surgery. Correlation of episodes of coughing with episodes of proximal or distal reflux was poor and had no useful predictive value. Patients with refractory chronic cough are significantly more likely to benefit from surgery if their pH study shows an upper channel pH time > 1%.