Successful resolution of refractory chronic cough induced by gastroesophageal reflux with treatment of baclofen

Gastroesophageal reflux induced cough (GERC) is a common cause of chronic cough and accounts for 5-41% of chronic cough. [1] Although proton pump inhibitors are a standard therapy for GERC, some patients do not respond to the antireflux medical treatment and remain a challenge to doctors. Here, we report three patients with GERC resistant to proton pump inhibitors but successfully treated with baclofen.A 26-year-old male patient with persistent cough for 3.5 years was referred to our respiratory clinic. He complained of cough day and night, with small amounts of viscous sputum. The accompanying symptoms included frequent clearing of the throat, occasional heartburn and acid regurgitation, but no post-nasal drip and chest pain (Table 1). The patient acknowledged a medical history of allergic rhinitis for 7 years, denied any exposure to environmental or occupational irritants, and never smoked. One year prior to the visit, he received a full diagnostic work-up in another respiratory clinic, where the results of laboratory investigations showed the normal chest radiographs and lung function, negative bronchial provocation to methacholine, positive IgE specific to dust mite and soybean in the serum, 1.5% of eosinophils in induced sputum, normal findings in fiberobronchoscope, and only submucosal edema with infiltration of scattered eosinophils and lymphocytes into airway mucosa as described by the pathologist examining the biopsy examples. A further 24-hour esophageal pH monitoring revealed an abnormal acid-reflux with a DeMeester score of 61.4 and the symptom association probability of 99%. Then, the presumptive diagnosis of GERC was established and oral omeprazole 20 mg twice a day was commenced. Three months later, his heartburn and acid regurgitation disappeared while the cough did not improve. The patient’s cough persisted despite the subsequent treatment with oral montelukast and inhaled corticosteroid.Physical examination showed no other abnormal findings except