The role of coughing as a gastroesophageal-reflux provoking maneuver: the scintigraphical evaluation

BACKGROUND: Attempts have been made to improve the positivity of the radionuclide detection of gastroesophageal reflux (GER). The aim of this study was to examine the possible contribution of coughing as a provoking maneuver in GER scintigraphy. METHODS: One hundred and twenty-five patients (mean age: 9.2+/-3.2 years) who had a clinical probability of having GER and were fully able to cooperate for coughing on command were included in the study. The patients were asked to cough gently four to six times per minute in the 2nd, 4th, and 6th 10-min periods within a 60-min total study time. The presence and number of GER episodes were noted for each period in all patients. RESULTS: Sixty-one of 125 patients (48.8%) showed no scintigraphic finding of GER and were interpreted as normal. In the remaining 64 patients (51.2%), GER was observed and these patients were interpreted as abnormal (GER+). Among patients with abnormal results, 25 (39%) presented GER episodes only during the coughing intervals of the study. In 33 (51.6%) patients, the reflux was seen both at coughing and noncoughing periods. In only six patients (9.4%) with GER in noncoughing periods, coughing did not provoke any reflux episodes. No overall correlation between cough-provoked frequency of reflux, number of GER episodes, and symptom severity was found in 64 GER+ patients (P>0.5); but in the subgroup of patients presenting GER episodes only during the coughing intervals, 60% (15 of 25), presented GER episodes only in one of the three cough-provoked intervals and also had the lowest symptom severity scores. CONCLUSION: The results of our study showed that 39% (25 of 64) of the observed GER findings were achieved exclusively by means of cough provocation.