AMA Publishing Group: Swallowing/Dysphagia Topic Collection

Antireflux Surgery in Patients With Chronic Cough and Abnormal Proximal Exposure as Measured by Hypopharyngeal Multichannel Intraluminal Impedance Antireflux Surgery in Patients With Chronic Cough

Hoppo T, Komatsu Y, Jobe BA. — Wed, 22 May 2013 00:00:00 GMT

Importance

Chronic cough is a laryngeal symptom that can be caused by gastroesophageal reflux disease; however, treatment outcome has been difficult to predict because of the lack of an objective testing modality that accurately detects reflux-related cough.

Objective

To define the patterns of reflux and assess the outcome of antireflux surgery (ARS) in patients with chronic cough who were selected using hypopharyngeal multichannel intraluminal impedance (HMII).

Design

Review of prospectively collected data.

Setting

Tertiary care university hospital.

Participants

Patients with chronic cough, which was defined as persistent cough (≥8 weeks) of unknown cause.

Interventions

Hypopharyngeal multichannel intraluminal impedance with a specialized catheter to detect laryngopharyngeal reflux and high-esophageal reflux (reflux 2 cm distal to the upper esophageal sphincter) and ARS.

Main Outcomes and Measures

Abnormal proximal exposure was defined as laryngopharyngeal reflux occurring 1 or more times per day and/or high-esophageal reflux occurring 5 or more times per day. The outcomes of ARS included symptomatic improvement.

Results

From October 2009 to June 2011, a total of 314 symptomatic patients underwent HMII. Of this population, 49 patients (15 men, 34 women; median age, 57 years) were identified as having chronic cough. Of the 49 participants, 23 of 44 patients (52%) had objective findings of gastroesophageal reflux disease, such as esophagitis. Abnormal proximal exposure was discovered in 36 of the 49 patients (73%). Of 16 patients with abnormal proximal exposure who subsequently underwent ARS, 13 patients (81%) had resolution of cough and 3 patients (19%) had significant improvement at a median follow-up of 4.6 months (range, 0.5-13 months).

Conclusions and Relevance

A highly selective group of patients with idiopathic chronic cough may have abnormal proximal exposure to gastroesophageal reflux documented by HMII that would have not been detected with conventional pH testing. Thus, HMII is likely to improve the sensitivity of laryngopharyngeal reflux diagnosis and better elucidate those who will respond to antireflux surgery.

Antireflux Surgery, a Cough Medicine Difficult to Swallow for Most Physicians Comment on “Antireflux Surgery in Patients With Chronic Cough and Abnormal Proximal Exposure as Measured by Hypopharyngeal Multichannel Intraluminal Impedance” ARS Difficult to Swallow

Patti MG. — Wed, 22 May 2013 00:00:00 GMT

This study by Hoppo and colleagues stresses many important aspects of the diagnosis and treatment of patients with chronic cough of unknown origin.

Radiology Quiz Case 2

Viets R, Scherl S, Clain JB, et al. — Wed, 01 May 2013 00:00:00 GMT

A 51-year-old man presented with a history of dysphagia and dysarthria. On physical examination, he was found to have a palpable mass in the left submandibular space, extending into the floor of the mouth. Tongue fasciculations and decreased movement of the tongue were also noted. A contrast-enhanced computed tomographic examination demonstrated a hypodense multilobulated mass in the left submandibular space with extension into the floor of the mouth and lateral displacement of the mylohyoid muscle (Figure 1 and Figure 2). Subsequent contrast-enhanced magnetic resonance imaging (MRI) scan demonstrated a T2 hyperintense and enhancing lesion centered in the left submandibular space with extension into the genioglossus and floor of the mouth (Figure 3 and Figure 4). A fine needle aspiration indicated a salivary gland neoplasm. The preoperative differential diagnosis centered on pleomorphic adenoma, while primary malignant lesion, metastatic disease to the submandibular gland and infection were considered less likely.