ArticleSurgical endoscopy2026
Gastroesophageal reflux disease (GERD)-associated chronic cough: long-term outcomes and predictors of response to anti-reflux surgery.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGERD-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.
methodsWe 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.
resultsAmong 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.
conclusionsLaparoscopic 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.
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