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. 2024 Jan-Dec:18:17534666231220819.
doi: 10.1177/17534666231220819.

Post-reflux swallow-induced peristaltic wave index: a new parameter for the identification of non-acid gastroesophageal reflux-related chronic cough

Bingxian Sha  1 , Wanzhen Li  1 , Haodong Bai  1 , Tongyangzi Zhang  1 , Shengyuan Wang  1 , Linyang Wu  1 , Wenbo Shi  1 , Yiqing Zhu  1 , Li Yu  2 , Xianghuai Xu  2
Affiliations

Post-reflux swallow-induced peristaltic wave index: a new parameter for the identification of non-acid gastroesophageal reflux-related chronic cough

Bingxian Sha et al. Ther Adv Respir Dis. 2024 Jan-Dec.

Abstract

Background: The current available diagnostic criteria for gastroesophageal reflux-related chronic cough (GERC) dominated by non-acid reflux is imperfect. The post-reflux swallow-induced peristaltic wave index (PSPWI) is a parameter reflecting esophageal clearance function.

Objectives: This study aims to investigate its diagnostic value for non-acid GERC.

Design: This study sought to compare the diagnostic value of PSPWI in different types of GERC, particularly non-acid GERC, and explore the clinical significance of PSPWI in the diagnosis of non-acid GERC through diagnostic experiments.

Methods: A retrospective analysis was performed based on 223 patients with suspected GERC who underwent multichannel intraluminal impedance-pH monitoring (MII-pH) in the outpatient clinic of our department from August 2016 to June 2021. Their clinical information, laboratory test results, and treatment responses were assessed and the underlying etiologies of chronic cough were categorized. The predictive value of the PSPWI in diagnosing different types of GERC, especially non-acid GERC, was analyzed and compared.

Results: A total of 195 patients with chronic cough who met the inclusion criteria underwent MII-pH monitoring. 143 patients had a definitive diagnosis of GERC, including 98 with acid GERC and 45 with non-acid GERC. The diagnostic value of PSPWI alone was moderate for GERC with an area under the working curve (AUC) 0.760, but poor for non-acid GERC with an AUC of 0.569. However, PSPWI < 39.8% combining with acid exposure time (AET) ⩽ 6.2% demonstrated a moderate diagnostic value for non-acid GERC, with an AUC of 0.722. When PSPWI < 39.8% combined with a non-acid reflux ratio >68.75%, the diagnostic value for non-acid GERC was improved (AUCROC = 0.80 versus AUCROC = 0.722, p < 0.05), which was significantly superior to non-acid symptom index (AUCROC = 0.804 versus AUCROC = 0.550, p < 0.05) and non-acid symptom association probability (AUCROC = 0.804 versus AUCROC = 0.571, p < 0.05).

Conclusion: PSPWI < 39.8% and AET ⩽ 6.2% have demonstrated good diagnostic value for non-acid GERC. The diagnostic value was further improved when combined with non-acid reflux ratio >68.75%.

Keywords: chronic cough; gastroesophageal reflux-related chronic cough; post-reflux swallow-induced peristaltic wave index.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
The diagnostic value of PSPWI, AET, DeMeester score, acid-SI and acid-SAP for acid-GERC. (a) ROC curve of PSPWI in predicting acid-GERC. (b) ROC curve of AET in predicting acid-GERC. (c) ROC curve of DeMeester score in predicting acid-GERC. (d) ROC curve of acid-SI in predicting acid-GERC and (e) ROC curve of acid-SAP in predicting acid-GERC. AET, acid exposure time; GERC, gastroesophageal reflux-related chronic cough; PSPWI, post reflux swallow induced peristaltic wave index; ROC, receiver operating characteristic; SAP, symptom-associated probability; SI, symptom index.
Figure 2.
Figure 2.
The diagnostic value of PSPWI, AET, DeMeester score, non-acid SI, and non-acid SAP for non-acid GERC. (a) ROC curve of PSPWI in predicting non-acid GERC. (b) ROC curve of AET in predicting non-acid GERC. (c) ROC curve of DeMeester score in predicting non-acid GERC. (d) ROC curve of non-acid SI in predicting non-acid GERC and (e) ROC curve of non-acid SAP in predicting non-acid GERC. AET, acid exposure time; GERC, gastroesophageal reflux-related chronic cough; PSPWI, post reflux swallow induced peristaltic wave index; ROC, receiver operating characteristic; SAP, symptom-associated probability; SI, symptom index.
Figure 3.
Figure 3.
The diagnostic value of several items for non-acid GERC. GERC, gastroesophageal reflux-related chronic cough.
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References

    1. Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest 2006; 129: 80S–94S. - PubMed
    1. Vakil N, van Zanten SV, Kahrilas P, et al.. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900–1920; quiz 1943. - PubMed
    1. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al.. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2022; 117: 27–56. - PMC - PubMed
    1. Ding H, Xu X, Wen S, et al.. Changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China. J Thorac Dis 2019; 11: 3482–3489. - PMC - PubMed
    1. Sifrim D, Mittal R, Fass R, et al.. Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms. Aliment Pharmacol Ther 2007; 25: 1003–1017. - PubMed