The results from the up-front esophageal testing seems to be valuable for discriminating people with reflux-related cough and for predicting proton pump inhibitors (PPI) response, says a study published in The American Journal of Gastroenterology. Researchers undertook this study to explore the usefulness of up-front esophageal testing for discrimination of reflux-related cough patients and for the prediction of PPI response.

Evaluation of endoscopy, demographic, and clinical findings; impedance-pH; and high-resolution manometry tracings from consecutive people evaluated for cough was done. The multi and univariable regression models were generated for determining the link between impedance-pH and high-resolution manometry findings; PPI response; and clinical and endoscopic characteristics.

Overall, 178 people were incorporated. Notably, 47.2% (84/178) of participants exhibited erosive esophagitis (grade C-D) or were characterized by positive symptom association  probability/symptom index and/or pathological acid exposure time (AET). Taking into account post reflux swallow-induced peristaltic wave (PSPW) and mean nocturnal baseline impedance (MNBI), 75.8% (135/178) of participants were characterized by the evidence of reflux disease.

Notably, 44.9% (n=80) were noted to have cough responding to PPIs. On the other hand, 55.1% (n=98) were non-responders. Both MNBI and PSPW were linked with PPI response at the receiver operating characteristic assessment. In comparison with AET and symptom association probability/symptom index, PSPW and MNBI index displayed greater sensitivity for the prediction of PPI response.

The area under the curves of PSPW and MNBI were found to be remarkably greater when compared to AET. Stratification of participants according to AET and eliminating those with erosive esophagitis illustrated that pathological PSPW or MNBI index, hypomotility features, and hiatal hernia were linked with PPI response in all the groups.