Are Gastrointestinal Symptoms in Chronic Cough Predictive of Positive Outcomes on EGD and Impedance Monitoring?

Introduction: Persistent cough lasting for more than 8 weeks is a common presenting complaint in primary care clinics and accounts for 38% of referrals to Aero-digestive clinic (ADC). Gastroesophageal reflux disease (GERD) has been implicated as one of the significant contributing factor. Reflux testing procedures such as EGD and multichannel intraluminal impedance testing (pH-MII) has been added to the evaluation of children with chronic cough as it increases the sensitivity of reflux detection in these patients. The aim of the study is to determine if the presence of GI symptoms in patients with chronic cough is associated with positive outcomes on EGD and Impedance monitoring. Methods: This is a retrospective study of 47 patients (63 % males and 36.9% females) who were referred to ADC at a large university hospital between August2013 to September2015 for evaluation of recalcitrant aerodigestive complaints. A chart review was conducted to record the presence of GI symptoms (nausea, vomiting, regurgitation, dysphagia, abdominal pain and distension), ENT symptoms (laryngitis and stridor) and pulmonary symptoms (chronic cough and asthma) as well as results of reflux testing procedures (EGD and pH-MII). Chi square test was performed to evaluate association between GI symptoms and positive results on EGD and pH-MII in patients with chronic cough. Results: The mean age at visit is 5 years-old with a range of 1 - 19 years-old. GI symptoms were present in 31 patients (67.39%). Reflux testing procedures were warranted for workup of chronic cough including EGD in 42 patients and intraluminal impedance testing in 19 patients. 20 of 42 (47.6%) patients had positive EGD findings and 11 of 19 (57.9%) had positive impedence testing. There was no statistical association between GI symptoms and positive outcome on EGD [X2=0.2971,p= 0.58] as well as GI symptoms and positive outcome on pH-MII testing [X2=0.0123, p= 0.91] Conclusion: Our results suggest that presence of GI symptoms is not correlated with positive outcomes of EGD or pH-MII when evaluating chronic cough. Although GERD most commonly presents with gastrointestinal symptoms like heartburn, regurgitation, nausea and vomiting; it can present with extraesophageal manifestations such as ENT symptoms (laryngitis), pulmonary symptoms (chronic cough, asthma) and cardiac symptoms (chest pain) with no concomitant gastrointestinal (GI) symptoms. These findings are important for clinical gastroenterologists evaluating chronic cough in ADC.