ReviewTherapeutic advances in respiratory disease
Refractory gastroesophageal reflux-related cough: Mechanistic insights and a rational pathway to phenotype-driven management.
Review in Therapeutic advances in respiratory disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This narrative synthesis proposes a hypothesis-generating, phenotype-stratified management algorithm for refractory GERC based on available evidence and clinical experience; prospective multicenter validation is needed to confirm its generalizability and long-term clinical efficacy. Gastroesophageal reflux-induced cough (GERC) accounts for 10-21% of chronic cough cases, with up to 43-75% presenting without typical heartburn or regurgitation. Current diagnostic frameworks lack translation into mechanism-specific treatment algorithms, leaving clinicians with empirical trial-and-error when standard acid suppression fails. This synthesis integrates six objective diagnostic metrics-acid exposure time, non-acid reflux episodes, cough-specific symptom association probability, post-reflux swallow-induced peristaltic wave index, mean nocturnal baseline impedance, and lower esophageal sphincter dual-defect-to classify four mechanistically distinct phenotypes (Types A-D), each matched to targeted therapy based on a comprehensive narrative synthesis of published therapeutic trials. The following response rates are derived from previously published historical cohorts and are not original data from the present study. In published historical cohorts, phenotype-matched therapy was associated with superior outcomes: Type B (clearance failure/non-acid) achieved 81.5% response with prokinetic combination versus 5.3% with escalated proton pump inhibitor monotherapy; Type C (structural dual-defect) attained 92% proton pump inhibitor-free status at 5 years post-fundoplication; Type D (cough hypersensitivity) showed 72% cough improvement with transoral incisionless fundoplication in cough-predominant patients; Type A (acid-dominant) received optimized potassium-competitive acid blocker suppression as the reference pathway. Structured deprescribing minimized polypharmacy for responders, while salvage pathways prioritized surgery for mechanical phenotypes. This phenotype-driven algorithm provides a mechanism-informed framework for managing refractory GERC, translating objective diagnostic metrics into targeted therapeutic escalation. Prospective validation is warranted to confirm improved clinical outcomes and cost-effectiveness.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.