Gastroesophageal reflux disease (GERD) is associated with an increased prevalence of cough, and physicians often empirically prescribe proton-pump inhibitors (PPIs) for patients with this symptom. Researchers conducted this meta-analysis to determine whether evidence exists to support this strategy.
Investigators identified 11 randomized controlled trials of antacid treatments in patients with GERD — 3 in children (200 patients) and 8 in adults (183 patients). The primary evaluated outcome was failure to eliminate cough. In the pediatric studies, some improvement was noted in GERD symptoms, but effects on cough were inconsistent, and not enough data were available for meta-analysis (no studies involved treatment with PPIs). Five of the adult studies contained enough data for meta-analysis (three involved treatment with PPIs and reported whether cough was cured clinically), and the results favored treatment; however, this result was not statistically significant (P=0.09). The number needed to treat to resolve cough was 5. Secondary outcomes (such as cough scores) also favored treatment, but again did not reach significance.
The effect of proton-pump inhibitors on cough symptoms might be somewhat beneficial, but existing studies are so small and varied, and their statistical power is so poor, that large well-designed randomized trials are needed before we can justify the widespread use of PPIs for cough. At the time of publication, the full text of the original article was available free of charge.
Reference:
Chang AB et al. Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux. BMJ 2006 Jan 7; 332:11-7.