Toux chronique de l’adulte et reflux gastro-œsophagien

Abstract

Respiratory manifestations represent one of the most prevalent and difficult to manage extra-esophageal syndromes of GORD. However, the relationship between reflux and respiratory symptoms such as chronic cough is frequently difficult to establish with a high degree of certainty. The causality of reflux in cough can be supported by several different pieces of evidence, including (1) a significant epidemiological association between GORD and respiratory symptoms, (2) a temporal relationship between cough occurrence and reflux episodes (as shown by pH or pH-impedance monitoring). The diagnosis of GORD is easily made if the patient complains of typical symptoms, such as heartburn and regurgitation, or if endoscopy shows unequivocal signs of esophagitis (i.e. mucosal breaks). However, in the case of GORD-related cough, the typical digestive syndrome is frequently absent, a situation corresponding to the so-called “silent GORD”. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and Proton Pump Inhibitors (PPI) in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring.