Wu D N, Tanifuji Y, Kobayashi H, Yamauchi K, Kato C, Suzuki K, Inoue H
Third Department of Internal Medicine, Iwate Medical University, Uchimaru Morioka, Japan.
Chest. 2000 Dec;118(6):1553-6. doi: 10.1378/chest.118.6.1553.
The effects of gastroesophageal reflux on airway hyperresponsiveness in patients with bronchial asthma have yet to be studied in significant detail. The purpose of the present study was to determine how esophageal acid perfusion could change airway responsiveness in patients with bronchial asthma.
In seven patients with bronchial asthma (mean +/- SD age, 55.1 +/- 6.4 years; four women and three men), esophageal pH was monitored by a pH meter and airway responsiveness was evaluated by aerosol inhalation of methacholine, during esophageal perfusion through an esophageal tube filled with either saline solution or 0. 1N hydrochloric acid (HCl), the order of which was selected at random, in 1-week intervals. Spirometry was also performed during esophageal pH monitoring.
A significant decrease in the geometric mean of airway sensitivity or the concentration of methacholine causing a 35% fall in respiratory conductance was observed during esophageal HCl perfusion compared with that of saline solution perfusion (p < 0.01 or p < 0.003), although no significant changes were observed in vital capacity, FEV(1), peak expiratory flow, respiratory resistance, or slope of respiratory conductance during the periods of saline solution and HCl perfusion.
We concluded that an increase in airway hyperresponsiveness was induced when HCl stimulated the esophagus in patients with bronchial asthma. These results suggest that esophageal reflux is one of the important factors that aggravate asthmatic status.
胃食管反流对支气管哮喘患者气道高反应性的影响尚未得到详细研究。本研究的目的是确定食管酸灌注如何改变支气管哮喘患者的气道反应性。
在7例支气管哮喘患者（平均年龄±标准差为55.1±6.4岁；4名女性和3名男性）中，通过pH计监测食管pH值，并在通过充满生理盐水或0.1N盐酸（HCl）的食管管进行食管灌注期间，通过雾化吸入乙酰甲胆碱评估气道反应性，灌注顺序随机选择，间隔1周。在食管pH监测期间也进行了肺活量测定。
与生理盐水灌注相比，在食管HCl灌注期间，观察到气道敏感性几何平均值或导致呼吸传导率下降35%的乙酰甲胆碱浓度显著降低（p<0.01或p<0.003），尽管在生理盐水和HCl灌注期间，肺活量、第1秒用力呼气容积（FEV₁）、呼气峰值流速、呼吸阻力或呼吸传导率斜率均未观察到显著变化。
我们得出结论，在支气管哮喘患者中，HCl刺激食管时会诱导气道高反应性增加。这些结果表明食管反流是加重哮喘病情的重要因素之一。
