Poe Robert H, Kallay Michael C
Pulmonary Unit, Highland Hospital, Strong Health System, Rochester, NY 14620, USA.
Chest. 2003 Mar;123(3):679-84. doi: 10.1378/chest.123.3.679.
To evaluate experience using a therapeutic trial of proton-pump inhibitor therapy with or without a prokinetic agent in diagnosis and treatment of gastroesophageal reflux disease (GERD)-related cough.
A review of experience with 214 patients with cough of > or = 3 weeks referred over 3.5 years. An anatomic diagnostic protocol was used to identify and treat those with GERD-related cough.
A pulmonary specialty practice affiliated with the University of Rochester School of Medicine and Dentistry.
One hundred eighty-three patients were identified with chronic cough and were included in the study. Thirty-one patients were disqualified because of abnormal chest radiographic findings, inadequate follow-up, or cough being not the primary complaint. Fifty-six patients were identified as having GERD-related cough.
A once-daily dose of a proton-pump inhibitor was prescribed. A prokinetic agent was added if esophageal dysfunction was suspected or response was inadequate. Those who did not respond underwent 24-h esophageal pH monitoring.
GERD was the single cause of cough in 24 patients (43%). Twenty-nine patients (52%) had GERD plus another cause, and 3 patients (5%) had GERD with more than two causes. Twenty-four patients (43%) had cough only, while 32 patients (57%) had other symptoms of GERD. Proton-pump therapy was successful in 42 patients (79%). Twenty-four patients responded to proton-pump inhibitor therapy, and 18 patients responded when metoclopramide or cisapride was added. The remaining two patients responded to a histamine type-2 blocker or cisapride alone. The cough was eliminated or markedly improved in 38 patients (86%) after 4 weeks and by 8 weeks in the remaining 6 patients. Six of the nonresponders had aspiration diagnosed by bronchoscopy. Four patients had fundoplication recommended, and two patients responded to alternative interventions.
Four to 6 weeks of a proton-pump inhibitor alone or in combination with a prokinetic agent successfully diagnoses and treats four of five patients with GERD-related cough. Twenty-four-hour esophageal pH monitoring will confirm the diagnosis in the others. These patients may be candidates for fundoplication. Nonresponders often aspirate as an additional aggravating factor.
评估在诊断和治疗胃食管反流病（GERD）相关咳嗽时，使用质子泵抑制剂治疗试验联合或不联合促动力药的经验。
回顾3.5年间转诊的214例咳嗽≥3周患者的经验。采用解剖学诊断方案来识别和治疗GERD相关咳嗽患者。
罗切斯特大学医学院和牙科学院附属的肺部专科诊所。
183例被确诊为慢性咳嗽的患者纳入研究。31例患者因胸部X光检查结果异常、随访不充分或咳嗽并非主要诉求而被排除。56例患者被确诊为GERD相关咳嗽。
每日服用一次质子泵抑制剂。若怀疑存在食管功能障碍或反应不充分，则加用促动力药。无反应者接受24小时食管pH监测。
GERD是24例患者（43%）咳嗽的唯一原因。29例患者（52%）GERD合并其他病因，3例患者（5%）GERD合并两种以上病因。24例患者（43%）仅有咳嗽，32例患者（57%）有GERD的其他症状。质子泵治疗对42例患者（79%）有效。24例患者对质子泵抑制剂治疗有反应，18例患者加用甲氧氯普胺或西沙必利后有反应。其余2例患者单独对组胺2型受体阻滞剂或西沙必利有反应。4周后，38例患者（86%）咳嗽消除或明显改善，其余6例患者在8周时改善。6例无反应者经支气管镜检查诊断为误吸。4例患者建议行胃底折叠术，2例患者对替代干预有反应。
单独使用质子泵抑制剂或联合促动力药治疗4至6周可成功诊断和治疗五分之四的GERD相关咳嗽患者。24小时食管pH监测可确诊其他患者。这些患者可能适合行胃底折叠术。无反应者常伴有误吸这一额外加重因素。
