Diagnostic pathways for gastroesophageal reflux cough: From empirical recognition to MII-pH-based multidimensional assessment.

BackgroundGastroesophageal reflux cough (GERC) is recognized as one of the leading etiologies of chronic cough. However, traditional diagnostic modalities suffer from exceptionally high misdiagnosis rates. This situation frequently puts clinicians in a dilemma of relying on empirical therapeutic trials.MethodsIntegrated with the 2024 Lyon Consensus 2.0, this review aims to explore the crucial value of 24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring in the precision diagnosis of GERC.Main findingsThis review first clarifies the fundamental role of exclusionary broad-spectrum screening and non-invasive initial assessments in early clinical triage. Then, it provides a deep analysis of the dual physical-chemical monitoring theories of MII-pH, systematically explains the four main index of this inspection method. Furthermore, by integrating High-Resolution Manometry (HRM) and oropharyngeal pH monitoring (Restech), this review to construct an individualized, stepwise clinical diagnostic pathway. In the end, this review lists the limitation of MII-pH,provokes the future outlook.ConclusionsMII-pH monitoring plays a critical role in the diagnosis of GERC. It provides assessment of reflux events and reflux-cough associations. Combined with other diagnostic tools, it improves the diagnostic accuracy and provides support for clinical decision making. Despite its limitations, in the future, with the development of technology, MII-pH shall be more valuable in the diagnosis of GERC.