Introduction Extra-oesophageal (ie laryngeal, pharyngeal and pulmonary) symptoms of gastro-oesophageal reflux (GOR) are common clinical problems. GOR can cause a chronic cough and its prevalence is higher in asthmatics than in the general population. Proton pump inhibitors (PPI) are the most effective available therapy but in those who remain symptomatic despite optimal medical therapy anti-reflux surgery is considered.
Method At our central England teaching hospital a database was set up for all respiratory patients with GOR who were referred for anti-reflux surgery. Symptoms were assessed at baseline (pre-surgery), 3 months post surgery and 12 months post surgery using the asthma quality of life questionnaire (AQLQ, range; 0 = worst -7 = best) and a cough symptom questionnaire (range; 0 = no cough -10 worst cough).
Results A total of 61 patients (70% females) with mean age of 48.64 (range 20 - 78 years) were analysed. 34 patients were asthmatics and 26 patients had a chronic cough. 1 patient was excluded as they had vocal cord dysfunction.
All patients had significant GOR confirmed by oesophageal manometry and pH reflux studies [mean DeMeester score of 46.6 (SD = 38.4, normal range <14.72), hypotonic mean lower oesophageal sphincter pressure of 5.7 mmHg (SD 3.78, normal range = 12–25) and a mean% reflux time of 11.9 (SD 8.98, normal range <4%)]. The baseline mean FEV1 in the asthma group was 2.08 (mean FEV1/FVC 0.72) compared to 2.61 (mean FEV1/FVC 0.81) in the cough group.
There was significant improvement in reflux symptoms. In the asthma group, the mean AQLQ score improved from baseline (3.05, SD = 0.8) to 3 months post surgery (3.68, SD = 0.9)(p = 0.0235), and 12 months post surgery (3.5, SD = 1.2) which did not reach statistical significance (p = 0.1) [see Figure 1]. There was also marked improvement in the cough symptom score from baseline (7.0, SD = 2.3) to 3 months post surgery (2.8, SD = 3.1) (p = <0.0001) [see Figure 1].
Conclusion In patients with evidence of severe GOR who remain symptomatic despite optimal medical management, anti-reflux surgery can improve cough and asthma related quality of life.