Fundoplicationinchronicintractablecough ShoaibFaruqi 1 PeterSedman 2 WarrenJackson 3 IanMolyneux 1 andAlynHMorice 1 Abstract Background Airwayrefluxisacommoncauseofchroniccoughandthisisoftenrefra ID: 955668
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RESEARCHOpenAccess Fundoplicationinchronicintractablecough ShoaibFaruqi 1* ,PeterSedman 2 ,WarrenJackson 3 ,IanMolyneux 1 andAlynHMorice 1 Abstract Background: Airwayrefluxisacommoncauseofchroniccoughandthisisoftenrefractorytomedicaltherapy. SurgeryintheformofNissenfundoplicationhasbeenhighlysuccessfulinthetreatmentoftheclassicreflux symptomsofheartburnanddyspepsia.Thereisapaucityofdataregardingresponsetofundoplicationinpatients presentingwithchroniccough. Methods: WeretrospectivelyreviewedthecasenotesofpatientsfromtheHullCoughClinicwhohadundergone Nissenfundoplicationoverthepast6years.Demographicdetails,durationofsymptoms,presenceofother symptoms,resultsofoesophagealstudies,outcomeandcomplicationswererecorded.Patientswerecontactedby postandaskedtocompleteaquestionnairedetailingcurrentsymptoms.Inasubgroupwithcontinued troublesomecough24hourpharyngealpHmeasurementswereundertaken. Results: Fortysevenpatientsunderwentfundoplication.Theaveragedurationofpre-operativecoughwas8years. Gastrointestinalsymptomswerepresentinthemajority.In30(64%)patientsapositiveresponsetotreatmentwas recorded.Milddysphagiaorbloatingwasseenin18patientsfollowingsurgery.Fourpatientsneededrepeat surgicalinterventionformodificationoffundoplication.Onepatientdevelopedaspirationpneumoniaeightweeks followingsurgeryanddiedofamyocardialinfarction.Twothirdsofpatientswithpersistingcoughhadevidenceof airwayrefluxonpharyngealpHmonitoring. Conclusion: Inthesepatientswithintractablecoughalongtermresponserateof63%representsauseful therapeuticoption.Treatmentfailureismorefrequentthanforclassicpepticsymptomsandmayberelatedto persistentgaseousreflux. Keywords: Chroniccough,Reflux,Fundoplication Introduction Inanumberofprospectiveseriesgastro-oesophagealre- fluxdisease(GORD)hasbeendemonstratedtobeasso- ciatedwithchroniccough.Thisassociationhasledto theimplicationthatGORDisacausalfactorinits pathogenesis.However,classicalGORDsymptomsof heartburn and dyspepsia areoftenabsentinpatients withothermanifestationsofairwayreflux.Nonor weaklyacidrefluxhasalsobeenimplicatedinthegen- esisofchroniccough.Thissuggeststhattherefluxcaus- ingcoughisunlikethatcausingGORDandmaybenon acidicorevengaseousinnature.Whilstanti-acidmedi- cationsareeffectiveintreatingtheclassicalpepticsymp- tomsofGORDandanempiricaltherapeutictrialis recommendedinguidelinesonthemanagementof refluxassociatedcoughtheefficacyofthistreatmentis muchmoremodest[1-3].Thissuggeststhatanalterna- tivetreatmentstrategyaimedatpreventingallformsof refluxmayhavearole. Surgicaltreatmentofrefluxbymeansoffundoplication, performedusingopenorlaparoscopictechniques,is thoughttoprovideaneffectivemechanicalbarrierto gastro-oesophagealrefluxandeliminatesbothacidand non-acidcomponents.Anumberofstudieshaveshown thatfundoplicationprovidesexcellentshortandlongterm controlofpepticsymptoms.Themostcommonlyper- formedprocedureistheNissen fundoplication[4,5].This wasinitiallydescribedasanopenprocedureandthelaparo- scopictechniquehasevolvedinthepasttwentyyears[6]. Althoughthereareseveralreportsofantirefluxsur- geryinpatientswith atypical respiratory,orlaryngeal symptoms[7-30],veryfewstudiesaredevotedto patientswithchroniccoughasthepresentingsymptom [13,16,23,24].Limitationsofthesestudiesincludesmall *Correspondence: sfaruqi@doctors.net.uk 1 DepartmentofCardiovascularandRespiratoryStudies,CastleHillHospital, HullYorkMedicalSchool,UniversityofHull,CottinghamHU165JQ,UK Fulllistofauthorinformationisavailableattheendofthearticle Cough ©2012Faruqietal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreative CommonsAttributionLicense(h
ttp://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,and reproductioninanymedium,providedtheoriginalworkisproperlycited. Faruqi etal.Cough 2012, 8 :3 http://www.coughjournal.com/content/8/1/3 numbersandlackoffollowup.HerewereporttheshortandlongtermresponseinpatientswithrefluxassociatedchroniccoughwhounderwentlaparoscopicNissenfun-doplication.ThiswasaretrospectivereviewandpostalsurveyofpatientsreferredforlaparoscopicNissenfun-doplicationfromtheHullCoughClinic.MethodologyPatientsAllpatientsundergoinglaparoscopicNissenfundoplicationatHullandEastYorkshireHospitalsTrustfromMay2003toApril2009whohadbeenreferredfromtheHullCoughClinicwereidentified.Patientshadbeenselectedforsur-geryonthebasisofaclinicaldiagnosisofrefluxassociatedchroniccoughusingourpreviouslydescribedcriteria[31].Patientshadtohavefailedmultiplemedicaltherapeutictrialsforrefluxassociatedcoughaswellaseosinophilicair-waydiseaseandrhinitis/postnasaldrip.Theseincludedacidsuppressivetherapy,prokinetics,baclofen,inhaledcortico-steroidsandfirstgenerationantihistamine.Ourmedicaltreatmentalgorithmforrefluxassociatedcoughincludes8weeksequentialtherapeutictrailsofacidsup-pressivetherapy(lansoprazole30mgbdwithranitidine300mgatnight),prokinetics(metoclopramide10mgtdsfollowedbydomperidone10mgtds)andbaclofen(5mgtdsandincreaseddependinguponresponse/toleranceto10mgtds)foritsactionontheloweroesophagealsphinc-ter.AllpatientsrecruitedgavewritteninformedconsentforlaparoscopicNissenfundoplication.Theyhadunder-goneastandardsetofpreoperativeassessmentswhichincluded24hourambulatoryoesophagealpHmonitoringandmanometry.ThepHmonitoringstudiesweredoneoffandacidsuppressivetherapy.Allpatientshadachestradio-graphwhichwasnormal.ThecasenotesofallthepatientsidentifiedwerereviewedindetailbySF.Thedemographicdetails,durationofsymptoms,priormedicaltreatment,resultsofinvestigationsandrecordedresponsetosurgeryandcomplicationsoflaparoscopicNissenfundoplicationwereelicited.Studyapprovalwasobtainedfromthehos-pitalauditcommitteeandconfirmedbytheethicscommit-teeofHullandEastRiding,UK.Pre-operativeassessmentAspreviouslydescribedoesophagealmotilitywasassessedbysolid-statemanometry[32].Ambulatory24hroesophagealpHwasmeasuredatalevelof5cmabovethepredetermined(viaoesophagealmanometry)upperborderoftheloweroesophagealsphincter(LOS).DatawaspresentedasDeMeesterscoreorpercentagetimethepHInterventionLaparoscopicNissenfundoplicationwasperformedinastandardfashionundergeneralanaesthesiawithfullmusclerelaxationusingafiveporttechnique[32].Ineverycasetheoesophagealhiatuswasfullydissectedandtheoesophagusmobilised.Atleastonenonabsorbablesuturewasplacedtoapproximatethecruraposteriortotheoesophagusandtominimisetheriskofpost-operativeherniation.Incaseswheretherewasalargepre-existinghiataldefect,additionalposteriorcruralsutureswereplacedasrequired.Inmostcasestherewasnoobvioushiatusherniademonstratedatsurgery.Cali-brationoftheoesophagealhiatuswasclinicalbutincasesofdoubta56Frendoluminalbougiewasavailabletocalibratetheappropriatesize.SymptomquestionnairesAllpatientsidentifiedwerecontactedbypostinAugust2009andwereaskedtocompleteandreturnaquestion-naire.Thisquestionnaireincluded100mmvisualanaloguescales(VAS)toassesscoughandheartburn/indigestion.PatientswereaskedtoindicateontheVASwhattheyperceivedtheirsymptomswerelikepriortothesurgeryandwhattheywerelikenow(atthetimeofcompletingthequestionnaire).Thescalerangedfromnottroubledextremelytroubled.Theyweresimi-larlyalsoaskedtocompletetheHullAirwayRefluxQuestionnaire(HARQ),aselfadministeredairwayrefluxspecificquestionnaire[33].Optiontoindicateinfreetextanythingelserelatedtoeithertheirsympto
ms,com-plicationsorthesurgerywasalsopresentinthequestionnaire.Theshorttermoutcomewasdecideduponreviewofthecasenotes.ResponseofcoughtolaparoscopicNis-senfundoplicationwasdividedintothreecategories:completeresponse,partialresponseandlackofre-sponse.Documentationinthenotesthatthecoughhadeitherresolvedorceasedtocauseanysubstantialdis-comfortwascategorisedasacompleteresponse.Ifitwasdocumentedthattherewasanimprovementincoughbutthecoughhadnotcompletelyresolvedandwascausingsignificantproblemsitwascategorisedasapartialresponse.Lackofresponsewasdocumentedassuch.Similarlytheoutcomesofheartburndigestionifpresentwererecorded.ThelongtermoutcomesweredecidedbasedupontheVASscoresforcoughfromthequestionnairesreturned.VASscoresforbothcoughandthepepticsymptomswereused.Complicationspostprocedurewererecordedonre-viewofcasenotesandreturnedquestionnaires.PharyngealpHmonitoringPharyngealairwaypHmonitoring(Restech)wasper-formedonpatientscontinuingtocomplainofreflux-etal.CoughPage2of7http://www.coughjournal.com/content/8/1/3 associatedcoughfollowinglaparoscopicNissenfundo-plication.AprobeisplacedintheoropharynxviathenasalrouteandmonitorsthepHinthesurroundingen-vironmentover24hours.Samplingfrequency(2Hz)issufficienttodetectshortlived,gaseousrefluxeventswhichmayberesponsiblefortriggeringcough.Analysisusesacompositescoringsystem(Ryanscore)basedonfrequencyanddurationofepisodeswherethepHcrossesalowerthreshold[34].Studiesarescoredsepar-atelyintheuprightandsupinepositions.StatisticalanalysisDemographicsandotherapplicabledataarepresenteddescriptively.TheVASscoresforcoughandpepticsymptomswereanalysedbytheWilcoxonsigned-ranktest.Fischersexacttestwasperformedtolookforpre-dictorsofsuccessfulresponseofcoughtolaparoscopicNissenfundoplication.Pvalueofwastakenasbeingsignificant.StatisticalanalysiswasperformedusingSPSSstatisticalsoftwarepackage,Chicago,Illinois,USA.Fortysevenpatients(36women,medianage55years)wererecruitedinthisstudy.Themediandurationofcoughwas5years(Table1).Pepticsymptomsweredocumentedinthecasenotestobepresentin85%ofthepatients.InallthepatientscoughwastheprimaryindicationforlaparoscopicNissenfundoplication.Pepticsymptomsbythemselveswerenotanindicationforsurgery.ShorttermoutcomeTheprimaryshorttermoutcomeofimprovementincoughwasseenin30patients(64%).Theresponsewascompletein45%andpartialin19%.Followingsurgerypepticsymptomsimprovedinallpatients.Thisissum-marisedinTable1.LongtermoutcomeThequestionnairewasreturnedby62%ofthepatients.Themeandurationoffollowuponreturnofquestion-nairewas3.8years.Themedian(range)presurgeryVASscoreforcoughwas94(36100)whichdecreasedto44100)atlongtermfollowup(p0.001).Asimilarim-provementwasseenbothintheheartburn/indigestionVASscoreaswellastheHARQ.Theseresultsaresum-marisedinTable2.Figure1demonstratestheindividualchangeintheVASscoresforcough.TheVASscoresforcoughandtheHARQscoreswerewellcorrelatedwiththecompleteresponse,partialresponseandlackofre-sponseasrecordedinthenotes.OnlyonepatientwasrecordedashavinganimprovementinhiscoughwhenhisVAScoughscorewasunchanged.Threepatientswererecordedashavinganimprovementintheirdys-pepticsymptomswhentheirVASscorewasunchanged.ThedecreaseinVASscoreforcoughcorrelatedwellwiththedecreaseinHARQscorefollowingfundoplica-tion(Spearmanscorrelationco-efficient=0.7,p0.001).ThisisshowninFigure2.PredictorsofoutcomeThefactorslookedatweregender,presenceofheartburn/dyspepsia,abnormalacidrefluxon24hourpHrecording,presenceofoesophagealdysmotilityanddecreasedloweroesophagealsphinctertone.Noneoftheseparameterswereasignificantdiscriminatorofoutcome.ResultsofpharyngealpHmonitoringIntwelvepatientswhoremainedsymptomaticpost-laparoscopicfundoplica
tionpharyngealpHstudieswereperformed.MeanHARQscoreinthisgroupwas44.2.Eightstudieswerepositiveintheuprightposition(meanRyanscore83.9,ULN9.41).All12studieswerenegativeinthesupineposition. Table1PatientcharacteristicsandoutcomeN47Women36Age(Median,Range)55(32Durationofcoughinyears(Median,Range)5.0(1Pepticsymptomspresentin85%Significantacidrefluxpresentin72%Decreasedloweroesophagealsphincterpressure28%Responsetotreatment64%Complete45%Partial19%PepticsymptomsincludedheartburnindigestionSignificantacidrefluxwasdocumentedtobepresentediftheDeMeesterscorewasgreaterthan14.7orifthetotalpercentagetimethepH5cmabovetheproximalborderoftheloweroesophagealsphincter,exceeded4.2%.Loweroesophagealsphinctertonewasdocumentedtobedecreasedifrestingpressurewaslessthan15mmHg. Table2LongtermoutcomesN29Median(range)VASscoreforcoughPresurgery94(36Onfollowup44(0100),(p0.001)Median(range)VASscoreforheartburn/indigestionPresurgery94(3Onfollowup16(0100),(p0.001)Median(range)VASHARQscorePresurgery50(10Onfollowup28(061),(p0.001)etal.CoughPage3of7http://www.coughjournal.com/content/8/1/3 Complications Seventeenpatientsperceiveddysphagiafollowingsurgery. In14thedysphagiawasmildanddidnotneedanyspe- cificintervention.In3patientstheNissenfundoplication neededconversiontoapartial(270°)fundoplicationand inonepatientthefundoplicationwasreversed.Three patientsperceivedasensationofbloating.Twopatients complainedofdiscomfortastheywerenotabletovomit. Onepatientdevelopedasmallleftsidedpleuraleffusion postoperatively.Thisresolvedwithoutanyspecifictreat- ment.A43yearoldwomanhadrecurrenceofdyspeptic symptomsandcoughtwoyearsfollowingfundoplication. Dyspepticsymptomshadresolvedandcoughhad improved,theresponsebeingpartial,followingthepro- cedure.Oninvestigationthefundoplicationwrapwas foundtobepartiallyundone.Shehadafurtherprocedure Figure1 IndividualchangeintheVASscoresforcoughisshown. TheVASscoresarewellcorrelatedwiththecompleteresponse,partial responseandlackofresponseasrecordedinthenotes. Figure2 ThechangeinHARQscoreandtheVASscoreforcoughisshown. ThedecreaseinVASscoreforcoughcorrelatedwellwiththe decreaseinHARQscorefollowingfundoplication(Spearman scorrelationco-efficient=0.7,p0.001). Faruqi etal.Cough 2012, 8 :3 Page4of7 http://www.coughjournal.com/content/8/1/3 toensureeffectivefundoplicationwhichledtotheameli-orationofdyspepticsymptomsandimprovementincough,whichagainwaspartial.A69yearoldwomanhadanepisodeofaspirationpneumoniaeightweeksfollowingsurgeryandsufferedfatalmyocardialinfarction.DiscussionWehavedemonstratedinourstudythataroundtwothirdsofpatientswithrefluxassociatedchroniccoughhaveasignificantresponsetoNissenfundoplication.Oftheresponderstwothirdshaveaverygoodresponsewitheithercompleteresolutionofcoughorreductionincoughtolevelswhichwerenolongerperceivedtobeaproblem.Thisresponsewassustainedonlongtermfol-lowup.AssuggestedbytheVASscores,ourpatientssufferedfromdebilitatingchroniccoughwhichweandothershavedemonstratedtohaveaprofoundimpactonqualityoflife.ThepostoperativereductioninVASscorewasnotuniformbutinthosewhorespondedrepresentsamarkedimprovement.FreetextcommentswrittenonthequestionnaireincludedMylifewaspurehellbeforetheoperationTheoperationchangedmylifeDelightedandwouldrecommendtoanyone.Whensuccessfulitisclearlyavaluabletreatmentoption.Refluxhasbeenincreasinglyimplicatedinthepathogen-esisofcoughinpatientspresentingtospecialistcoughclinics[3].Lackofconsensusondiagnosticcriteriaofextra-oesophagealrefluxmakesitdifficulttoexactlyquan-tifytheassociation.Conventionalcriteriabasedondur-ationofoesophagealacidexposureobservedintwentyfourhourpHstudiesareapplicableonlytothepepticsymptomsofGORD.I
mpedancemeasurementsdemon-stratethatnon/weaklyacidrefluxisresponsibleformanyextra-oesophagealsymptomssuchascoughanddyspho-nia[3].Ourdatasuggeststhatpersistentgaseousrefluxoccursinpatientsfailingfundoplication.Thusthenatureofrefluxleadingtocoughmaybedifferentfromthatcaus-ingGORDinthatnonacid,gaseousrefluxatehasalead-ingrole.Intheabsenceofgoodobjectivediagnosticteststheclinicalhistoryisimportantinestablishingthediagnosisofrefluxassociatedchroniccough.Symptomswhichsuggestthediagnosisinclude:coughonphonation,onrisingfrombed,associatedwithcertainfoodsoreating[31].Inthevalidationofourquestionnaire,HARQ,designedtodetectairwayrefluxheartburnindiges-hadtheweakestpredictiveprobability[32].Onethirdofpatientshadlittleornoresponseintermsofcoughalthoughimprovementinthesymptomsofheartburnandregurgitation(datanotshown)wasalmostinvariable.Therelativelyhighnumbersofpatientswithre-fluxrelatedcoughhavingdyspepticsymptomsinourco-hortmayreflectourbiasinselectingthosewithadditionalsymptomsknowntoimprovewithfundoplication.Infact,thepresenceofdyspepsiadidnotpredictasuccessfulout-comeincough,suggestingdifferentmechanismsunder-lyingthegenesisofthesesymptoms.InpatientsnotrespondingtoNissenfundoplicationpharyngealpHmoni-toringdemonstratedsignificantpersistentrefluxinthemajority.UnliketheliquidrefluxofGORDwhichiselimi-natedbyfundoplicationthegaseousrefluxcausingcoughmaypersist.Thereisasignificantcomplicationrateassociatedwithfundoplication,chiefofwhicharegasbloatanddyspha-gia.Unfortunately,wewereunabletoidentifyfactorspredictingasuccessfuloutcomeandsointhosepatientswithisolatedcoughcarefulconsiderationoftheriskbenefitratioisrequired.LaparoscopicNissenfundopli-cationcanbetakendownifthereareintolerablecompli-cationsandnobenefitandwehaveundertakenthisinonepatientinthiscohort.Therehavebeenanumberofreportsoftheexperienceoffundoplicationforavarietyofindicationsincludingpatientswithrespiratorysymptoms.AllenandAnvarireportedtheircohortof905[18].Ofthe209patientswithsomerespiratorysymptoms,83%hadcough.Coughwasreportedtohaveimprovedin83%at6months,74%at2yearsand71%at5years.Kaufmanetal.reportedtheretrospectivelongtermoutcomesin750patientswhohadundergonefundoplicationofwhom231hadexperiencedcough,hoarsenessorwheezingonceperweek[12].Atamedianfollowupof53monthstherewasadurableandstatisticallysignificantfallincoughassessedbyasymptomquestionnaire.Resolutionofcoughwasobservedin41%andimprovementin74%.Veryfewstudieshavelookedintochroniccoughaloneasaprimaryindicationforfundoplication.Inthelargest,aprospectivestudyof21consecutivepatientsundergoingNissenfundoplicationforrefluxassociatedchroniccoughcompleteresolutionwasobservedin62%andconsiderableimprovementin76%[23].Thustheresultsofourstudyareverysimilartothatreportedinliterature.LaparoscopicNissenfundoplicationisarelativelysafeprocedure.Inaretrospectivereviewofover2000anti-refluxprocedures1deathwasobserved[25].Anotherstudyof148proceduresreportedperi-operativemorbid-ityandmortalitytobe8.8%and0.7%respectively[19].RelativelymildcomplicationsofNissenfundoplicationaregastro-paresis,dysphagiaandbloating.Becauseofthenatureoftheprocedureatransientdegreeofdys-phagiaisexperienced.Inamajorityofpatientsthisimproveswithouttheneedforanyspecificintervention.Rarelyeitherareversal,conversiontoapartialfundopli-cationoroesophagealdilatationisneeded.Ourstudywasretrospectivefollowupofpatientsandlackedacontrolarm.Coughtherapyisknowntohaveastrongplaceboeffectandthiscannotberuledouteveninapatientpopulationthathadrepeatedlyfailedmedicaletal.CoughPage5of7http://www.coughjournal.com/content/8/1/3 therapyIdeallywewouldhaveinvestigatedpharyngealpHpreandpostoperatively;howevert
histestingwasnotclin-icallyindicatedandwouldthereforehaverequiredinformedconsent.Thiswouldhavealsoprovedprohibi-tivelyexpensive.WeusedaVASscoretoevaluateresponsetotreatmentandthismaybesubjecttoarecallbias.Allotherstudiesevaluatingtheroleofanti-refluxsurgeryonchroniccougharealsouncontrolledandnotblinded.Theyalsodifferinthebasisonwhichadiagnosisofrefluxasso-ciatedchroniccoughandhowtheoutcomewasassessed.Arandomisedcontrolledtrialisurgentlyneededtofullyevaluatethistreatment.CompetinginterestsNoneoftheauthorshaveanycompetinginterestsrelevanttothisstudy.SFandAHMdesignedthisstudyandevaluatedpatientsinthecoughclinicfortheprocedure.SFcollectedthedataandanalysedtheresults.WJperformedtheoesophagealandpharyngealstudies.PSisthesurgeonwhoperformedthefundoplicationforthesubjects.IMcollectedthepharyngealpHdataonthesubjectswithpersistentsymptomsfollowingfundoplicationandanalysedtheresultsofthesame.SFwrotetheinitialdraftofthemanuscriptandconductedthestatisticalanalysis.AHMandSFfurthereditedthemanuscriptwhichwasapprovedbyallauthors.Allauthorsreadandapprovedthefinalmanuscript.AuthordetailsDepartmentofCardiovascularandRespiratoryStudies,CastleHillHospital,HullYorkMedicalSchool,UniversityofHull,CottinghamHU165JQ,UK.DepartmentofUpperGastrointestinalandMinimallyInvasiveSurgery,CastleHillHospital,HullYorkMedicalSchool,UniversityofHull,CottinghamHU165JQ,UK.DepartmentofUpperGastro-IntestinalPhysiology,CastleHillHospital,HullYorkMedicalSchool,UniversityofHull,CottinghamHU165JQ,Received:5April2012Accepted:29June2012Published:19July20121.MoriceAH,McGarveyL,PavordI,BritishThoracicSocietyCoughGuidelineRecommendationsforthemanagementofcoughinadults.Thorax(Suppl1):i12.MoriceAH,FontanaGA,SovijarviAR,PistolesiM,ChungKF,WiddicombeJ,O'ConnellF,GeppettiP,GronkeL,DeJongsteJ,BelvisiM,DicpinigaitisP,FischerA,McGarveyL,FokkensWJ,KastelikJ,ERSTaskForce:Thediagnosisandmanagementofchroniccough.EurRespirJ3.ChandraKM,HardingSM:TherapyInsight:treatmentofgastroesophagealrefluxinadultswithchroniccough.NatClinPractGastroenterolHepatol4.BroedersJA,DraaismaWA,BredenoordAJ,SmoutAJ,BroedersIA,GooszenLong-termoutcomeofNissenfundoplicationinnon-erosiveanderosivegastro-oesophagealrefluxdisease.BrJSurg5.PessauxP,ArnaudJP,DelattreJF,MeyerC,BaulieuxJ,MosnierH:Laparoscopicantirefluxsurgery:five-yearresultsandbeyondin1340ArchSurg6.DallemagneB,WeertsJM,JehaesC,MarkiewiczS,LombardR:Nissenfundoplication:preliminaryreport.SurgLaparoscEndosc7.HamdyE,El-ShahawyM,AbdEl-ShoubaryM,AbdEl-RaoufA,El-HemalyM,SalahT,El-HanafyE,GadElHakN:ResponseofatypicalsymptomsofGERDtoantirefluxsurgery.8.IqbalM,BatchAJ,MoorthyK,CooperBT,SpychalRT:Outcomeofsurgicalfundoplicationforextra-oesophagealsymptomsofreflux.SurgEndosc9.CataniaRA,KavicSM,RothJS,LeeTH,MeyerT,FantryGT,CastellanosPF,ParkA:LaparoscopicNissenfundoplicationeffectivelyrelievessymptomsinpatientswithlaryngopharyngealreflux.JGastrointestSurg10.RansonME,DanielsonA,MaxwellJG,HarrisJA:ProspectivestudyoflaparoscopicNissenfundoplicationinacommunityhospitalanditseffectontypical,atypical,andnonspecificgastrointestinalsymptoms.11.SalminenP,SalaE,KoskenvuoJ,KarvonenJ,OvaskaJ:Refluxlaryngitis:afeasibleindicationforlaparoscopicantirefluxsurgery?SurgLaparoscEndoscPercutanTech12.KaufmanJA,HoughlandJE,QuirogaE,CahillM,PellegriniCA,OelschlagerLong-termoutcomesoflaparoscopicantirefluxsurgeryforgastroesophagealrefluxdisease(GERD)-relatedairwaydisorder.13.TutuianR,MainieI,AgrawalA,BloomstonM,AlbrinkM,GoldinS,RosemurgyA:Nonacidrefluxinpatientswithchroniccoughonacid-suppressivetherapy.14.RakitaS,VilladolidD,ThomasA,BloomstonM,AlbrinkM,GoldinS,RosemurgyA:LaparoscopicNissenfundoplicationoffershig
hpatientsatisfactionwithreliefofextraesophagealsymptomsofgastroesophagealrefluxdisease.AmSurg15.LiuJJ,Carr-LockeDL,OstermanMT,LiX,MaurerR,BrooksDC,AshleySW,SaltzmanJR:Endoscopictreatmentforatypicalmanifestationsofgastroesophagealrefluxdisease.AmJGastroenterol16.ZioraD,JaroszW,DzielickiJ,CiekalskiJ,KrzywieckiA,DworniczakS,KozielskiCitricacidcoughthresholdinpatientswithgastroesophagealrefluxdiseaserisesafterlaparoscopicfundoplication.17.MainieI,TutuianR,AgrawalA,HilaA,HighlandKB,AdamsDB,CastellDO:Fundoplicationeliminateschroniccoughduetonon-acidrefluxidentifiedbyimpedancepHmonitoring.18.AllenCJ,AnvariM:Doeslaparoscopicfundoplicationprovidelong-termcontrolofgastroesophagealrefluxrelatedcough?SurgEndosc19.DuffyJP,MaggardM,HiyamaDT,AtkinsonJB,McFaddenDW,KoCY,HinesLaparoscopicNissenfundoplicationimprovesqualityoflifeinpatientswithatypicalsymptomsofgastroesophagealreflux.AmSurg20.BrouwerR,KiroffGK:ImprovementofrespiratorysymptomsfollowinglaparoscopicNissenfundoplication.ANZJSurg21.AllenCJ,AnvariM:PreoperativesymptomevaluationandesophagealacidinfusionpredictresponsetolaparoscopicNissenfundoplicationingastroesophagealrefluxpatientswhopresentwithcough.SurgEndosc22.ThomanDS,HuiTT,SpyrouM,PhillipsEH:Laparoscopicantirefluxsurgeryanditseffectoncoughinpatientswithgastroesophagealrefluxdisease.JGastrointestSurg23.NovitskyYW,ZawackiJK,IrwinRS,FrenchCT,HusseyVM,CalleryMP:Chroniccoughduetogastroesophagealrefluxdisease:efficacyofantirefluxsurgery.SurgEndosc24.IrwinRS,ZawackiJK,WilsonMM,FrenchCT,CalleryMP:Chroniccoughduetogastroesophagealrefluxdisease:failuretoresolvedespitetotal/near-totaleliminationofesophagealacid.25.GreasonKL,MillerDL,DeschampsC,AllenMS,NicholsFC3rd,TrastekVF,PairoleroPC:Effectsofantirefluxproceduresonrespiratorysymptoms.AnnThoracSurg26.FarrellTM,RichardsonWS,TrusTL,SmithCD,HunterJG:Responseofatypicalsymptomsofgastro-oesophagealrefluxtoantirefluxsurgery.JSurg27.EkströmT,JohanssonKE:Effectsofanti-refluxsurgeryonchroniccoughandasthmainpatientswithgastro-oesophagealrefluxdisease.28.ChenRY,ThomasRJ:Resultsoflaparoscopicfundoplicationwhereatypicalsymptomscoexistwithoesophagealreflux.AustNZJSurg29.PattiMG,ArceritoM,TamburiniA,DienerU,FeoCV,SafadiB,FisichellaP,WayLW:Effectoflaparoscopicfundoplicationongastroesophagealrefluxdisease-inducedrespiratorysymptoms.JGastrointestSurg30.AllenCJ,AnvariM:Gastro-oesophagealrefluxrelatedcoughanditsresponsetolaparoscopicfundoplication.31.EverettCF,MoriceAH:Clinicalhistoryingastroesophagealcough.etal.CoughPage6of7http://www.coughjournal.com/content/8/1/3 32.FathiH,MoonT,DonaldsonJ,JacksonW,SedmanP,MoriceAH: Coughin adultcysticfibrosis:diagnosisandresponsetofundoplication. Cough 2009, 5: 1. 33.MoriceAH,FaruqiS,WrightCE,ThompsonR,BlandJM: Cough hypersensitivitysyndrome:adistinctclinicalentity. Lung 2011, 189 (1):73 79. 34.AyaziS,LiphamJC,HagenJA,TangAL,ZehetnerJ,LeersJM,OezcelikA, AbateE,BankiF,DeMeesterSR,DeMeesterTR: Anewtechniquefor measurementofpharyngealpH:normalvaluesanddiscriminatingpH threshold. JGastrointestSurg 2009, 13 (8):1422 1429. doi:10.1186/1745-9974-8-3 Citethisarticleas: Faruqi etal. : Fundoplicationinchronicintractable cough. Cough 2012 8 :3. Submit your next manuscript to BioMed Central and take full advantage of: Convenient online submission Thorough peer review No space constraints or color gure charges Immediate publication on acceptance Inclusion in PubMed, CAS, Scopus and Google Scholar Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Faruqi etal.Cough 2012, 8 :3 Page7of7 http://www.coughjournal.com/content/8/1/