Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management

Table 2 Evaluation of therapeutic options for refractory chronic cough due to gastroesophageal reflux

Therapeutic options	Evaluations
Pharmacologically
Optimization of PPIs therapy
Switch to another PPI	Useful for some refractory cough due to acid reflux
Doubling the current dose of PPI	Useful for refractory cough due to severe acid reflux
Add-on therapy
Histamine H2 receptor antagonists	Useful for refractory cough due to severe acid reflux and night-time reflux
TLESRs inhibitors (baclofen)	Useful for refractory cough due to acid or non-acid reflux resistant to PPI therapy
Gabapentin	Useful for refractory cough due to acid or non-acid reflux resistant to PPI and baclofen therapy
Surgically
Laparoscopic fundoplication	A treatment option for long-term therapy of refractory cough due to acid or non-acid reflux
Endoscopic therapy or transoral incisionless fundoplication	Not recommended for refractory cough due to reflux on the basis of lack of long-term efficacy
Radiofrequency augmentation	Not recommended for refractory cough due to reflux on the basis of lack of long-term efficacy

PPI: Proton pump inhibitor. TLESRs: transient lower esophageal sphincter relaxations.