Effectiveness of transoral endoscopic fundoplication with or without hiatal hernia repair in patients with gerd and chronic cough.

AIMS

Gastroesophageal Reflux Disease (GERD) is a common cause of chronic cough. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) may be suitable treatments. We studied the effectiveness of TIF/cTIF in patients with chronic cough and proven GERD.

METHODS

Patients with proven GERD from 9 centers (TIF registry) were evaluated before and at a minimum of 6 months post TIF/cTIF. Patients with cough-predominant phenotype were identified (chief complaint of cough and reflux symptom index (RSI) troublesome cough subscore ≥ 2) and compared to those without. The primary outcome was improvement in RSI score compared to baseline. Secondary outcomes were normalization of RSI, improvement in RSI cough sub-scores, GERD symptom improvement, discontinuation of proton pump inhibitor, and patient satisfaction.

RESULTS

One hundred and ninety-eight patients underwent TIF/cTIF. Follow-up for 177 patients (median 12 months [IQR 6,12]) showed decrease in median RSI score from 18 [IQR 13, 27] to 5 [IQR 2, 11] (p < 0.0001). Eighty-three percent of patients with elevated baseline RSI normalized their scores. Seventy-five percent and 72% had improvement in cough when lying down and troublesome cough, respectively. Eighty-three percentsuccessfully discontinued or decreased PPI. Satisfaction improved from 5.6% at baseline to 68.8% (p < 0.0001). Patients with cough-predominant phenotype (n = 63) experienced an additional 5-point decrease in in RSI score (p = 0.01). Patients with typical GERD symptoms were more likely to have a favorable response for cough symptoms (p < 0.0001).

CONCLUSION

TIF/cTIF are effective barrier therapies for patients with cough-predominant pH-positive GERD.