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A cough caused by gastroesophageal reflux disease (GERD) may persist despite treatment to suppress gastric acid. In that case, the problem may be caused by non-acid reflux, suggesting that antireflux surgery may be the best way to treat the condition, according to a report in the medical journal Chest.

While some doctors simply rule out a diagnosis of GERD when acid suppression doesn't work, Dr. Radu Tutuian and his colleagues theorized that some people may have gastroesophageal reflux that is not detected by conventional monitoring of acidity in the esophagus.

Their study included 50 patients referred to their institution, the Medical University of South Carolina in Charleston, between 2002 and 2005, whose cough did not resolve while being treated with twice-daily pills to shut off stomach acid production.

By monitoring esophageal impedance as well as acidity, the team found that 13 patients (26 percent) had had reflux without acid. These patients consulted a surgeon, and six decided to undergo laparoscopic surgery designed to stop stomach contents backing up into the esophagus.

Tutuian's team reports that five of the six patients who could be contacted over a period of a year or longer said they were free of symptoms and were not taking acid-suppressing medication.

The researchers conclude that up to a quarter of patients with persistent reflux-related cough may have non-acid reflux, and they might benefit from surgery -- but larger studies are need to verify these preliminary data.

SOURCE: Chest, August 2006.