Coughing on heaven’s door: resolution of severe refractory cough following Roux-en-Y gastric bypass: a case report

Background Chronic cough can severely impair quality of life, particularly when associated with gastroesophageal reflux disease (GERD) and cough hypersensitivity syndrome (CHS). Conventional treatments often fail in refractory cases. Although laparoscopic Roux-en-Y gastric bypass (LRYGB) is established for GERD and obesity, its role in chronic cough remains poorly understood. We report a case of refractory GERD-associated CHS with dramatic and sustained cough resolution following LRYGB, objectively confirmed by ambulatory cough monitoring. Case presentation A 47-year-old white Swiss woman with a 5-year history of severe, treatment-resistant chronic cough underwent extensive evaluation, confirming gastroesophageal reflux disease (GERD)-associated cough hypersensitivity syndrome (CHS). Despite maximal pharmacological therapy and prior anti-reflux surgery (anterior hemifundoplication and hiatoplasty), her cough remained debilitating, profoundly disrupting sleep and leading to suicidal ideation. Ambulatory cough monitoring documented a high objective cough burden. She subsequently underwent conversion to LRYGB. Within six weeks, objective cough frequency decreased dramatically, with sustained symptom resolution at ten months follow-up. No perioperative complications occurred. Conclusion This case suggests that LRYGB may be associated with dramatic and sustained cough resolution in carefully selected patients with severe, treatment-refractory GERD-associated cough hypersensitivity syndrome. A key lesson is the value of ambulatory cough monitoring, which objectively quantifies cough burden and treatment response and may provide useful information when evaluating treatment response in severe chronic cough.