Analysis Of The Gastroesophageal Reflux Characteristics And Anxiety And Depression In Patients With Chronic Cough

ObjectiveThis study applies 24-hour multichannel intraluminal impedance and pH monitoring(24h MII-pH),self-rating anxiety scale(SAS)and self-rating depression scale(SDS),and so forth,to analyze the property of acidity and alkalinity of gastroesophageal reflux in patients with chronic cough,the relationship between reflux and body position,the correlation between cough symptoms and reflux conducts,the accompanying symptoms of cough,as well as the relationship between cough and anxiety/depression,etc.Then have some discussions on the correlation between gastroesophageal reflux and chronic cough,and the states of anxiety and depression,and even the possible pathogenesis of them,on the purposes of improving the understanding of this confusing disease,and providing an important basis for the clinical diagnosis and treatments.MethodsA retrospective analysis of 137 patients with chronic cough and no positive findings under gastroscopy who visited the Respiratory Clinic of the First Affiliated Hospital of Guangzhou Medical University from June 29,2016 to October 12,2020 was performed.After giving out general individual conditions and accompanying symptoms of cough,filling GERD Q,Cough Q,SAS,SDS,and conducting 24h MII-pH,the above 137 patients who did not suffer from upper gastrointestinal surgeries nor ulcers,bile reflux,and malignant tumors under gastroscopy were divided into NERD group and non-NERD group according to whether there was pathological acid exposure(DeMeester score≥ 14.7 points)under 24h MII-pH.1.Compare the general conditions of patients in the NERD group and the non-NERD group;4.2.Compare the 24h MII-pH parameters in the NERD group and the non-NERD group;3.Compare the frequency of the accompanying symptoms of cough;4.Compare the scores of daytime/nigh time cough symptoms in the NERD group and non-NERD groups;5.Compare the differences in acid-base property of reflux in chronic cough patients with or without anxiety/depression;6.Compare the correlation between GERD Q and 24h MII-pH as diagnostic criterion of GERD.Outcomes1.The general situation of the two groups of patients:no significant difference has been found in the ratio of gender,age,weight,and height between the NERD group and the non-NERD group;BMI of the NERD group was greater than that of the non-NERD group(P<0.05).2.24h MII-pH parameters(1)pH monitoring indicators:DeMeester scores,total AET,upright AET,acid reflux times,and prolonged acid reflux times(>5s)in the NERD group were significantly higher than those in the non-NERD group(P<0.01),and the recumbent AET was higher in the NERD group.In the non-NERD group(P<0.05),there was no significant difference in the longest reflux time between the two groups(P>0.05).(2)Impedance monitoring indicators:acid reflux in NERD group was more than that in NERD group(P<0.05),and there was no significant difference in weak acid and weak base reflux between the two groups(P>0.05).The reflux episodes of acid reflux,weak acid reflux and weak base reflux in upright position in both two groups were significantly higher than those in supine position(P<0.05).(3)Cough-reflux correlation probability(SAP>95%):in this case,137 patients enrolled were found to have correlations between liquids(acidic,weakly acidic,weakly alkaline)and gases(acidic and weakly acidic)reflux(SAP>95%)and cough,and weak acidic liquid reflux enjoyed the highest correlation.The weak alkaline gas had no correlation found(SAP<95%).3.Symptoms accompanied by cough:from most to least:acid reflux(27.5%)>belching(24.1%)>heartburn(18.5%)>globus/discomfort in swallowing(16.1%)>chest tightness/chest pain(11.7%).4.Results of cough symptom scores:daytime and nighttime cough scores in the NERD group were both significantly higher than those in the non-NERD group(P<0.01).5.The relationship between anxi ety/depr es si on and cough:patients with anxiety/depression had higher cough symptom scores(P<0.05),among which the higher the degree of anxiety,the heavier the cough(P<0.01).6.The correlation between GERD Q and 24h MII-pH as diagnostic criterion of GERD:GERD Q≥8 points and 24h MII-pH calculation DeMeester score≥14.7 points were used as diagnostic criterion for GERD.For the sample in this case,no statistically significant correlation has found.ConclusionsThere was no significant difference in the general condition between patients with chronic cough,and they tend to have weak acidic in the standing position.Pathological acid exposure and anxious/depressive states may worsen cough symptoms.Acid reflux,belching,and heartburn were the top 3 accompanying symptoms(>70%)of patients with chronic cough in this study.GERD Q has a limited role in the diagnosis of GERD and is not suitable as a diagnostic tool alone.