Predictive factors for neuromodulator response in patients with nonacid gastroesophageal reflux-induced chronic cough: a retrospective data analysis.

BACKGROUND

Nonacid gastroesophageal reflux-induced cough (GERC) remains understudied, with limited research on effective treatment options. Recently, neuromodulators such as gabapentin and baclofen have shown promise in managing nonacid GERC.

OBJECTIVES

This study aimed to identify factors associated with response to neuromodulator therapy in nonacid GERC.

STUDY DESIGN

A retrospective study.

METHODS

We analyzed medical records of patients diagnosed with nonacid GERC who received gabapentin or baclofen as an add-on therapy enrolled between December 2019 and January 2024. Retrospective analysis of general information, cough-related questionnaires, MII-pH parameters, and other assessments was conducted to establish a regression analysis model for identifying multiple factors associated with neuromodulator response.

RESULTS

In this retrospective cohort study, data from 184 patients were analyzed, with 106 (57.6%) classified as responders and 78 (42.4%) as nonresponders. Clinical factors significantly associated with neuromodulator efficacy included gender (OR = 4.324,  = 0.027), age (OR = 0.803,  = 0.002), and exposure to cough-aggravating factors (OR = 6.345,  < 0.001). Furthermore, multiple regression analysis further identified specific Hull Airway Reflux Questionnaire (HARQ) items-"Cough with certain foods" (OR = 2.523,  = 0.034), "Cough with eating" (OR = 4.445,  < 0.001), and "Cough brought on by singing or speaking" (OR = 5.003,  = 0.007)-as significant predictors. Additionally, Medication Adherence Questionnaire (MAQ) items such as "Forgetfulness" (OR = 0.257,  = 0.005) and "Stopping medication when "feeling better" (OR = 0.787,  = 0.017) were also identified as significant predictors of treatment response.

CONCLUSION

Neuromodulators can relieve nonacid GERC in patients unresponsive to standard anti-reflux therapy. Factors such as male gender, younger age, less exposure to cough irritants, and higher HARQ and lower MAQ scores can effectively predict the efficacy of neuromodulators.