GERD cough limitations.docVIP

Defining the relationship between gastroesophageal reflux and cough: probabilities, possibilities and limitations Matthew M Eastburn1,2 , Peter H Katelaris3 and Anne B Chang1,4 1? Department of Respiratory Medicine, Royal Childrens Hospital, Brisbane, Australia 2? School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Queensland, Australia 3? Department of Gastroenterology, University of Sydney, Concord Hospital, Sydney, Australia 4? Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia author email corresponding author email Cough 2007, 3:4doi:10.1186/1745-9974-3-4 Abstract The common co-existence of cough and gastroesophageal reflux disease (GORD) is well established. However, ascertaining cause and effect is more difficult for many reasons that include occurrence by chance of two common symptoms, the changing definition of GORD, equipment limitations and the lack of randomised controlled trials. Given these difficulties, it is not surprising that there is disparity of opinion between respiratory and gastroenterology society guidelines on the link between GORD and chronic cough. This commentary explores of these issues. Background The first guideline on the management of cough championed by Irwin [1] made a significant positive impact. Not surprisingly other guidelines on chronic cough [2-5] have since been published. American [2], European [3] and British [5] respiratory guidelines for the management of chronic unexplained cough in adults advocate empirical treatment of gastroesophageal reflux disease (GORD) with a variety of medications including proton pump inhibitors (PPIs). In contrast, guidelines from some national gastroenterological societies are less definitive about the association between cough and GORD [6-9] Paediatric cough guidelines do not favour the empirical approach in adults because GORD as a cause of isolated cough is rare in children [10,11]. Is there evidence