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In primary care settings, consideration should be given to employing the GerdQ algorithm for managing patients with gastroesophageal reflux-induced chronic cough.
In a prospective, parallel-group, randomized clinical trial, researchers have unveiled a new structured pathway (NSP) for relieving gastroesophageal reflux-induced chronic cough (GERC). According to the findings, a symptom-based approach using the gastroesophageal reflux disease questionnaire (GerdQ) is more beneficial for GERC sufferers experiencing significant reflux impact, guiding appropriate medical treatment and minimizing the unnecessary use of medical resources.
This study published in "Therapeutic Advances in Respiratory Disease" assessed the effectiveness of anti-reflux therapy utilizing the GerdQ-based approach (referred to as the NSP) against conventional medical treatment following multichannel intraluminal impedance-pH monitoring (MII-pH) (known as the Ordinary Clinical Pathway, OCP) for managing GERC. Surprisingly, the NSP exhibited comparable efficiency to the OCP in relieving GERC, according to non-inferiority analysis (95% confidence interval, -4.97 to 17.73, p = 0.009).
Moreover, those following the NSP experienced a faster improvement in cough symptoms and cough threshold by week 8, indicating its potential for more rapid relief. What sets the NSP apart is its simplicity. By adopting the GerdQ score as the basis for treatment decisions, clinicians can swiftly navigate the management of GERC without the need for complex testing like MII-pH. Subgroup analyses further revealed that people suffering from low-likelihood GERC (GerdQ < 8) may benefit more from the OCP, whereas those with high-likelihood and low-reflux impact GERC (GerdQ > 8 and GerdQ Impact Scale [GIS] < 4) showed no inferiority to the OCP when following the NSP.
These findings suggest that GerdQ- and GIS-driven diagnosis and treatment can serve as a viable substitute for MII-pH in resource-constrained settings. This strategy not only simplifies patient care but also optimizes resource utilization in primary care settings. In conclusion, the study underscores the importance of considering the GerdQ algorithm in the primary care management of patients with GERC. By embracing this simplified approach, clinicians can deliver efficient treatment while conserving valuable resources, marking a vital advancement in the field of gastroesophageal reflux-related cough management.
Therapeutic Advances in Respiratory Disease
A comparison between a gastroesophageal reflux disease questionnaire-based algorithm and multichannel intraluminal impedance-pH monitoring for the treatment of gastroesophageal reflux-induced chronic cough
Wanzhen Li et al.
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