Predictive factors for neuromodulator response in patients with nonacid gastroesophageal reflux-induced chronic cough: a retrospective data analysis.

Abstract

Background: Nonacid gastroesophageal reflux-induced cough (GERC) remains understudied, with limited research on effective treatment options. Recently, neuromodulators such as gabapentin and baclofen have shown promise in managing nonacid GERC.

Objectives: This study aimed to identify factors associated with response to neuromodulator therapy in nonacid GERC.

Study design: A retrospective study.

Methods: We analyzed medical records of patients diagnosed with nonacid GERC who received gabapentin or baclofen as an add-on therapy enrolled between December 2019 and January 2024. Retrospective analysis of general information, cough-related questionnaires, MII-pH parameters, and other assessments was conducted to establish a regression analysis model for identifying multiple factors associated with neuromodulator response.

Results: In this retrospective cohort study, data from 184 patients were analyzed, with 106 (57.6%) classified as responders and 78 (42.4%) as nonresponders. Clinical factors significantly associated with neuromodulator efficacy included gender (OR = 4.324, p = 0.027), age (OR = 0.803, p = 0.002), and exposure to cough-aggravating factors (OR = 6.345, p < 0.001). Furthermore, multiple regression analysis further identified specific Hull Airway Reflux Questionnaire (HARQ) items-"Cough with certain foods" (OR = 2.523, p = 0.034), "Cough with eating" (OR = 4.445, p < 0.001), and "Cough brought on by singing or speaking" (OR = 5.003, p = 0.007)-as significant predictors. Additionally, Medication Adherence Questionnaire (MAQ) items such as "Forgetfulness" (OR = 0.257, p = 0.005) and "Stopping medication when "feeling better" (OR = 0.787, p = 0.017) were also identified as significant predictors of treatment response.

Conclusion: Neuromodulators can relieve nonacid GERC in patients unresponsive to standard anti-reflux therapy. Factors such as male gender, younger age, less exposure to cough irritants, and higher HARQ and lower MAQ scores can effectively predict the efficacy of neuromodulators.