T1693 High Nitrate Intake May Be Related to GERD: An Ecologic Study

Background: Association of acid gastroesophageal reflux (AGER) with cough has been demonstrated in adult patients with cystic fibrosis (CF). We previously showed that use of combined esophageal pH monitoring and multichannel intraluminal impedance (EPM/MII) reveals 4 distinct types of AGER episodes; classic two-phase, single-phase, pH only, and re-reflux AGER episodes. Specific Aim: To investigate the question whether specific types of AGER might predict coughing in CF patients. Methods: 24-hr EPM/MII reports from 27 CF patients (no anti-reflux meds and no fundoplication) were reviewed. Patients for whom analysis demonstrated an association of AGER with cough (co-occurrence within 5-min windows with SAP ≥95%) were analyzed. Total AGER episodes within this subset of patients were divided into AGER types and analyses were repeated. Results: 1) Association of AGER with coughing was detected in 9 of 27 CF patients (5M/4F, median age 18.5yrs, range 6.148.5yrs). 2) Of those selected patients, the mean number of AGER was 133 (Range 69 to 231) in which 28% were two phase, 13% were single phase, 53% were pH only events, and 6% were re-reflux (Friedman p<0.001). 3) The mean percent events associated with cough were 29.4% for two phase, 33.7% for single phase, 24.9% for pH only events, and 32.9% for re-reflux (Friedman p=.31). Summary and Conclusions: While two-phase and pH only episodes occurred more often than single-phase and re-reflux episodes, specific types of AGER did not predict cough. We conclude that all AGER types should be considered when assessing the association of AGER with cough in CF patients.