Everett C F, Morice A H
Academic Department of Medicine, Respiratory Medicine, University of Hull, Castle Hill Hospital, Cottingham, UK.
Minerva Gastroenterol Dietol. 2004 Sep;50(3):205-13.
Gastroesophageal reflux (GOR) disease is one of the 3 commonest causes of chronic cough. It can be difficult to diagnose as the traditionally recognised symptoms of GOR, such as heartburn and acid regurgitation, are often absent. More subtle indicators of a link between the cough and the oesophagus should therefore be sought. These include cough which occurs in relation to eating or phonation, cough which settles at night and does not tend to wake the patient from sleep and symptoms suggestive of laryngopharyngeal reflux. Investigations such as oesophageal manometry and 24 hour pH monitoring can be useful in characterising any underlying oesophageal abnormality, but may underestimate the problem since non-acid reflux can precipitate cough. Empirical trials of treatment are therefore often employed, but should be continued for at least 2 months, as symptoms can be slow to improve due to plasticity of the cough reflex. Pharmacologic treatment options include proton pump inhibitors, H2 receptor antagonists, pro-motility agents and liquid alginate preparations. Surgical fundoplication can also be effective when performed in appropriately selected individuals.
胃食管反流（GOR）病是慢性咳嗽最常见的3个病因之一。由于胃食管反流传统上公认的症状，如烧心和反酸，常常不存在，所以该病可能难以诊断。因此，应该寻找咳嗽与食管之间联系的更细微指标。这些指标包括与进食或发声有关的咳嗽、夜间缓解且不会使患者从睡眠中惊醒的咳嗽以及提示喉咽反流的症状。食管测压和24小时pH监测等检查对于明确任何潜在的食管异常可能有用，但可能会低估问题，因为非酸性反流也可引发咳嗽。因此，常常采用经验性治疗试验，但应持续至少2个月，因为由于咳嗽反射的可塑性，症状改善可能较慢。药物治疗选择包括质子泵抑制剂、H2受体拮抗剂、促动力剂和液体藻酸盐制剂。对于经过适当选择的个体，手术行胃底折叠术也可能有效。
