90th Annual Meeting Abstracts
ANTIREFLUX SURGERY IN THE SETTING OF PHYSIOLOGIC REFLUX FOR THE INDICATION OF COUGH
Richard A Perugini, MD, John J Kelly, MD, Demetrius EM Litwin, MD, MBA, *Donald R Czerniach, MD
University of Massachusetts Medical Center, Worcester, MA
Objective:There is a growing conception among pulmonologists that gastroesophageal reflux disease (GERD) is the most common cause of chronic cough. The surgical community has long recognized that antireflux surgery is not as successful at curing cough, as typical symptoms of GERD. We present a series of patients referred for laparoscopic antireflux procedure from pulmonary medicine with the primary indication of GERD-induced cough.
Design: Continuous series
Setting: Tertiary care hospital
Patients: Four female with negative methacholine challenge tests and with a mean age of 48 + 5
Interventions: 360º fundoplication
Main Outcome Measures: Subjective assessment of symptoms six weeks postoperatively
Results: The 24 hour pH probe results were consistent with physiologic reflux; % time pH < 4 in the distal esophagus was 1.7 + 1.9, and the average DeMeester score was 7.0 + 5.4. Impedence manometry demonstrated 66 + 23 total reflux episodes (normal <73), 32 + 15 of which reached the proximal esophagus. Correlation of cough to reflux was 44 + 20%. No patient reported complete resolution of cough at six weeks. Subjective assessments of symptom improvement ranged from 0-75%. Longer term follow up indicated cough was unchanged in 2 of 4 patients, and only minimally improved in one. One patient noted 70-80% improvement.
Conclusions: The population referred for GERD-induced cough is distinct from that referred for typical symptoms of GERD. Our early exploration of antireflux surgery for the sole indication of cough has poor outcomes with regards to symptom control, suggesting caution and further research in this field.