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The chronic
cough caused by gastroesophageal reflux disease (GERD) is
not always caused by acid, according to researchers at the
University of Massachusetts Medical School in Worcester. Drug
therapy, including intensive acid suppression, may not improve
GERD's chronic cough.
"There
is a subgroup of patients with chronic cough whose intragastric
or stomach acidity can be completely or nearly completely
suppressed with acid therapy yet they can still have their
cough due to GERD," said Dr. Richard S. Irwin of UM.
"What we've found is that chronic cough is caused not
only by acid, but by non-acid mediators such as enzymes as
well."
For these
patients, antireflux surgery can eliminate or significantly
improve the chronic cough, the researchers reported in the
journal of the American College of Chest Physicians.
In a study
of 8 patients (7 women, 1 man) with chronic cough due to GERD
whose symptoms did not improve with drug therapy, the researchers
reported that the coughs of all eight either disappeared or
were markedly improved after surgery. . Positive results were
still seen one year later and long-term follow-up found the
results still present from 2.5 to 4 years after surgery.
"The
charge of any physician is to improve patient care and quality
of life," said Dr. Sidney S. Braman, president of the
American College of Chest Physicians. "As a result of
this study, we now have a better idea of what's causing the
chronic cough and can recommend treatment options for those
patients who don't respond to widely used therapies."
Source:
Medical Week staff,
week of April 14, 2002
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