A Comparison Between a Gastroesophageal Reflux Disease Questionnaire-based Algorithm and Multichannel Intraluminal Impedance-pH Monitoring for the Treatment of Gastroesophageal Reflux-induced Chronic Cough

Overview

Journal Ther Adv Respir Dis

Publisher Sage Publications

Specialties Pharmacology
Pulmonary Medicine

Date 2024 Jan 6

PMID 38183243

Authors

Wanzhen Li

Tongyangzi Zhang

Wenhua Gu

Wenbo Shi

Shengyuan Wang

Yiqing Zhu

Cuiqin Shi

Li Yu

Xianghuai Xu

Affiliations

Soon will be listed here.

Abstract

Background: Empiric therapy with multichannel intraluminal impedance-pH monitoring (MII-pH) has been used for the initial treatment of gastroesophageal reflux-induced chronic cough (GERC). However, an algorithm based on the gastroesophageal reflux disease questionnaire (GerdQ) has the potential to achieve a simple, structured, and effective treatment approach for patients with GERC.

Objectives: This study compared the efficacy of anti-reflux therapy based on GerdQ (new structured pathway, NSP) with medical treatment after MII-pH examination (ordinary clinical pathway, OCP) in the management of GERC.

Design: For the NSP, we adapted the GerdQ score to establish the basis for a treatment algorithm. For the OCP, treatment was determined using the MII-pH examination results.

Methods: The non-inferiority (NI) hypothesis was used to evaluate NSP OCP.

Results: Overall, the NSP and OCP-based therapeutic algorithms have similar efficacy for GERC [NI analysis: 95% confidence interval (CI), -4.97 to 17.73, = 0.009; superiority analysis: = 0.420]. Moreover, the cough symptom scores and cough threshold improved faster in the NSP group than in the OCP group at week 8 ( < 0.05). In the subgroup analyses using the GerdQ and GerdQ impact scale (GIS) scores, patients with low-likelihood GERC (GerdQ < 8) were more likely to benefit from OCP (NI analysis: 95% CI, -19.73 to 18.02, = 0.213). On the other hand, in patients with high-likelihood and low-reflux impact GERC patients (GerdQ > 8 and GIS < 4), the NSP arm was not inferior to the standard treatment of OCP (NI analysis: 95% CI, -8.85 to 28.21%, = 0.04; superiority analysis: = 0.339), indicating that GerdQ- and GIS-guided diagnosis and management of patients with GERC could be an alternative to MII-pH management, especially in settings with reduced medical resources.

Conclusions: The use of the GerdQ algorithm should be considered when handling patients with GERC in the primary care setting.

Trial Registration: This research was registered in the Chinese Clinical Trials Registry (ChiCTR-ODT-12001899).

Citing Articles

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Li W, Wang S, Zhang T, Zhu Y, Yu L, Xu X Biomolecules. 2025; 15(2).

PMID: 40001589 PMC: 11852612. DOI: 10.3390/biom15020285.

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