Abstract
Hiatal hernia (HH) may coexist with gastroesophageal reflux-related chronic cough (GER, CC). The study aimed to evaluate whether the presence of HH was related to CC severity and the response to anti-reflux therapy. This was a retrospective analysis of data on adults with GER-related CC managed in our cough center between 2017 and 2021. Patients who had undergone chest CT and in whom follow up data were available were included. The presence and size of HH were assessed based on thorax CT scanning. Patients were treated with modification of diet and proton pump inhibitors. The response to treatment was assessed by the change in quality of life (QOL) measured by Leicester Cough Questionnaire (LCQ) and cough severity was measured by 100 mm Visual Analogue Scale (VAS). Forty five adults (28 F, 17 M) were included. HH was demonstrated in 12 patients (26.6%). Patients with HH did not differ from those without HH in clinical characteristics, cough duration and severity, and cough-related QOL. We found moderate positive correlations between maximal sagittal diameter of HH and cough severity (rho=0.692, p=0.013) and duration (rho=0.720, p=0.008). Patients without HH responded better to anti-reflux therapy with significant LCQ improvement. A strong negative correlation between sagittal diameter of HH gate and increase in LCQ (rho=-0.764, p=0.004) was demonstrated. The presence of HH identified in chest CT may impact cough severity, duration and response to anti-reflux treatment in patients with GER-related CC. Further prospective studies are justified to confirm significance of HH in the management of CC.
Footnotes
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Conflict of interest: We declare that MD has received fees from Merck for consultations and lectures on chronic cough, outside the submitted work. EMG has received honorary for lectures on chronic cough from Merck and Polpharma, outside the submitted work. ARF has received fee from Polpharma for attendance at ERS International Congress (2019), outside the submitted work. RK has received honorary for lectures from Chiesi, AstraZeneca, Polpharma, outside the submitted work; Boehringer Ingelheim, Chiesi and AstraZeneca have covered his fee and travel expenses for ERS International Congresses (2018, 2019) and ATS Conferences (2018, 2019), outside the submitted work.
Conflict of interest: OT, JZ and KBG declare no conflict of interest.
Conflict of interest: The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the study apart from those disclosed.
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- Received December 2, 2022.
- Accepted January 24, 2023.
- Copyright ©The authors 2023
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