Ziora Dariusz, Jarosz Wojciech, Dzielicki Józef, Ciekalski Jacek, Krzywiecki Andrzej, Dworniczak Szymon, Kozielski Jerzy
Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Koziolka 1, Poland.
Chest. 2005 Oct;128(4):2458-64. doi: 10.1378/chest.128.4.2458.
It has been reported that antireflux surgery can diminish chronic cough due to gastroesophageal reflux disease (GERD) that is resistant to pharmacologic therapy. The aim of this study was the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to GERD before and 3 months after laparoscopic Toupet fundoplication.
Thirty subjects (20 women and 10 men; median age, 45.3 years) with chronic cough due to GERD and 15 healthy volunteers underwent cough challenge with doubling concentrations of citric acid. Twenty subjects with GERD, a group of 14 women and 6 men (mean age, 45.5 years), underwent the same protocol 3 months after laparoscopic fundoplication. Daytime and nighttime cough score questionnaires (verbal category descriptive score) were completed in all groups.
The geometric mean of CACT was significantly lower in GERD patients (9.62 mg/mL) than in healthy volunteers (50.8 mg/mL, p < 0.001). The results of cough score measurement significantly improved within 2 weeks after laparoscopic surgery. In 13 weeks of postoperative follow-up, cough disappeared or was greatly improved in 14 of the 20 patients (70%); in 3 other patients, cough resolved partially. In three patients. there was no improvement in cough. Cough challenge after surgery revealed a significant increase in mean cough threshold, from 8.28 to 19.03 mg/mL (p < 0.05).
The results suggest that GERD influences CACT, which was significantly lower in GERD patients compared to healthy subjects. A significant correlation was found between subjective and objective measurements of cough in GERD patients. We found laparoscopic fundoplication to be objectively beneficial in GERD-induced chronic cough, as it reduced the CACT.
据报道，抗反流手术可减轻因胃食管反流病（GERD）导致的、对药物治疗无效的慢性咳嗽。本研究的目的是评估腹腔镜Toupet胃底折叠术前后3个月，GERD所致慢性咳嗽患者的柠檬酸咳嗽阈值（CACT）。
30例因GERD导致慢性咳嗽的受试者（20例女性和10例男性；中位年龄45.3岁）及15名健康志愿者接受了柠檬酸浓度加倍的咳嗽激发试验。20例GERD患者，其中14例女性和6例男性（平均年龄45.5岁），在腹腔镜胃底折叠术后3个月接受了相同方案的试验。所有组均完成了白天和夜间咳嗽评分问卷（言语类别描述性评分）。
GERD患者的CACT几何平均值（9.62mg/mL）显著低于健康志愿者（50.8mg/mL，p<0.001）。腹腔镜手术后2周内咳嗽评分测量结果显著改善。术后13周的随访中，20例患者中有14例（70%）咳嗽消失或明显改善；另外3例患者咳嗽部分缓解。3例患者咳嗽无改善。术后咳嗽激发试验显示平均咳嗽阈值显著升高，从8.28mg/mL升至19.03mg/mL（p<0.05）。
结果表明，GERD影响CACT，GERD患者的CACT显著低于健康受试者。GERD患者咳嗽的主观和客观测量之间存在显著相关性。我们发现腹腔镜胃底折叠术对GERD引起的慢性咳嗽有客观益处，因为它降低了CACT。
