Improved diagnostic yield of symptom association probability involving only cough for gastroesophageal reflux-induced chronic cough

Zhang, Li; Zhang, Mengru; Chen, Qiang; Sun, Huihui; Bian, Xiujuan; Xu, Xianghuai; Yu, Li; Qiu, Zhongmin

Abstract

Background: Use of symptom association probability (SAP) is recommended for identifying gastroesophageal reflux-induced chronic cough (GERC). This study aimed to compare the diagnostic yield of SAPs involving only cough (C-SAP) or total symptoms (T-SAP) for GERC identification. Methods: Patients with both chronic cough and other reflux-related symptoms underwent multichannel intraluminal impedance-pH monitoring (MII-pH) between January 2017 and May 2021. C-SAP and T-SAP were calculated based on the patient-reported symptoms. GERC was definitively diagnosed by the favorable response to anti-reflux therapy. The diagnostic yield of C-SAP in identifying GERC was evaluated by receiver operating characteristic curve analysis and compared with that of T-SAP. Results: MII-pH was performed in 105 patients with chronic cough, and GERC was confirmed in 65 (61.9%), including 27 (41.5%) cases of acid GERC and 38 (58.5%) cases of non-acid GERC. The positive rates of C-SAP and T-SAP were comparable (34.3% vs. 23.8%, P>0.05), but C-SAP exhibited a higher sensitivity (53.85% vs. 33.85%, χ²=8.117, P=0.004) and similar high specificities (97.5% vs. 92.5%, P>0.05) compared with T-SAP for GERC identification. C-SAP was also more sensitive for recognition of acid GERC (51.85% vs. 33.33%, χ²=7.386, P=0.007) and non-acid GERC (65.79% vs. 39.47%, χ²=14.617, P<0.001). More GERC patients with positive C-SAP needed intensified anti-reflux therapy for cough resolution when compared with those with negative C-SAP (82.9% vs. 46.7%, χ²=9.449, P=0.002). Conclusions: C-SAP was superior to T-SAP for the identification of GERC and may improve the diagnostic yield of GERC.

Citation

Zhang, L., Zhang, M., Chen, Q., Sun, H., Bian, X., Xu, X., Yu, L., & Qiu, Z. (2023). Improved diagnostic yield of symptom association probability involving only cough for gastroesophageal reflux-induced chronic cough. Journal of thoracic disease, 15(4), 2277-2287. https://doi.org/10.21037/jtd-22-1016

• Journal Article Type: Article
• Acceptance Date: Mar 3, 2023
• Online Publication Date: Mar 30, 2023
• Publication Date: Apr 28, 2023
• Deposit Date: Jun 17, 2025
• Publicly Available Date: Jun 17, 2025
• Journal: Journal of Thoracic Disease
• Print ISSN: 2072-1439
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 4
• Pages: 2277-2287
• DOI: https://doi.org/10.21037/jtd-22-1016
• Keywords: Cough; diagnostic accuracy; diagnostic yield; gastroesophageal reflux; symptom association probability (SAP)
• Public URL: https://hull-repository.worktribe.com/output/5239654