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Background <p>GERD-associated chronic cough exhibits variable and incompletely understood responses to anti-reflux therapy. Long-term outcomes and preoperative predictors of cough resolution (CR) following laparoscopic anti-reflux surgery remain poorly defined.</p> Methods <p>We conducted a retrospective cohort study of patients who underwent laparoscopic hiatal hernia repair with fundoplication at a single institution between January 2011 and December 2024. Patients were included if they have reported preoperative cough and completed validated quality-of-life questionnaires––including the Reflux Symptom Index (RSI) and GERD Health-Related Quality of Life (GERD-HRQL)––at 1-or 2-year follow-up. The primary outcome was CR, defined as an RSI cough sub-score ≤ 1 postoperatively. Univariable and multivariable logistic regression identified predictors of persistent postoperative cough.</p> Results <p>Among 205 patients with adequate follow-up, CR was achieved in 126 (61.5%), with a combined resolution/improvement rate of 72.7%. Patients who achieved CR had significantly lower preoperative RSI scores (21.2 ± 11.1 vs. 28.0 ± 8.9, <i>p</i> = 0.0004) and lower cough severity scores (2.6 ± 1.8 vs. 3.9 ± 1.7, <i>p</i> &lt; 0.0001). Postoperatively, CR patients demonstrated superior symptom scores across all domains through 2&#xa0;years. There were 49 patients with follow-up data at 5&#xa0;years (23.9%). At 5&#xa0;years, there were no significant differences in RSI and symptom scores between groups (10.2 ± 9.0 vs. 10.6 ± 8.8, <i>p</i> = 0.77). On multivariable analysis, non-sliding hiatal hernias (Type II–IV) were independently associated with lower odds of persistent postoperative cough (OR 0.46, 95% CI 0.23–0.90, <i>p</i> = 0.02). Among patients with documented normal postoperative pH testing, only 55.4% achieved complete CR.</p> Conclusions <p>Laparoscopic anti-reflux surgery achieves durable CR in approximately 61% of patients with GERD-related chronic cough. Lower preoperative RSI scores and non-sliding hiatal hernia type predict favorable outcomes. Convergence of symptom scores at 5&#xa0;years suggests that delayed improvement is common, underscoring that early persistence of cough should not be interpreted as surgical failure.</p> Graphical abstract <p></p>

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Gastroesophageal reflux disease (GERD)-associated chronic cough: long-term outcomes and predictors of response to anti-reflux surgery

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Colin Wang,
  • Emil Maric,
  • Kristine Kuchta,
  • Miracle Burt,
  • Kristen Castelino,
  • Jonathan Lang,
  • Mohammed Rasheed,
  • Lucy Hinton,
  • H. Mason Hedberg,
  • Natalie Liu,
  • Michael Ujiki

摘要

Background

GERD-associated chronic cough exhibits variable and incompletely understood responses to anti-reflux therapy. Long-term outcomes and preoperative predictors of cough resolution (CR) following laparoscopic anti-reflux surgery remain poorly defined.

Methods

We conducted a retrospective cohort study of patients who underwent laparoscopic hiatal hernia repair with fundoplication at a single institution between January 2011 and December 2024. Patients were included if they have reported preoperative cough and completed validated quality-of-life questionnaires––including the Reflux Symptom Index (RSI) and GERD Health-Related Quality of Life (GERD-HRQL)––at 1-or 2-year follow-up. The primary outcome was CR, defined as an RSI cough sub-score ≤ 1 postoperatively. Univariable and multivariable logistic regression identified predictors of persistent postoperative cough.

Results

Among 205 patients with adequate follow-up, CR was achieved in 126 (61.5%), with a combined resolution/improvement rate of 72.7%. Patients who achieved CR had significantly lower preoperative RSI scores (21.2 ± 11.1 vs. 28.0 ± 8.9, p = 0.0004) and lower cough severity scores (2.6 ± 1.8 vs. 3.9 ± 1.7, p < 0.0001). Postoperatively, CR patients demonstrated superior symptom scores across all domains through 2 years. There were 49 patients with follow-up data at 5 years (23.9%). At 5 years, there were no significant differences in RSI and symptom scores between groups (10.2 ± 9.0 vs. 10.6 ± 8.8, p = 0.77). On multivariable analysis, non-sliding hiatal hernias (Type II–IV) were independently associated with lower odds of persistent postoperative cough (OR 0.46, 95% CI 0.23–0.90, p = 0.02). Among patients with documented normal postoperative pH testing, only 55.4% achieved complete CR.

Conclusions

Laparoscopic anti-reflux surgery achieves durable CR in approximately 61% of patients with GERD-related chronic cough. Lower preoperative RSI scores and non-sliding hiatal hernia type predict favorable outcomes. Convergence of symptom scores at 5 years suggests that delayed improvement is common, underscoring that early persistence of cough should not be interpreted as surgical failure.

Graphical abstract