Chronic cough and oesophageal disorders

Oesophageal disorders are rarely considered in the aetiology of CC. However, vagal hypersensitivity and the extra-oesophageal manifestations of the condition are suggested by their close anatomical and physiological relationships. Oesophageal dysmotility is a common finding, but other disorders such as hiatus hernia, diffuse oesophageal spasm and gastro-oesophageal reflux occur. In contrast to acid reflux, airway reflux, a gaseous non-acid mist, may be responsible for many of the extra-oesophageal complaints in CC with deposition in the upper airway and larynx, and aspiration into the lung. Potential treatment options include promotility agents (5-HT 4 and motilin agonists) octreotide, and surgical fundoplication in selected patients.