Matyásová Z, Novotná B, Matulová M, Dolina J, Kroupa R, Láníková Z, Znojil V, Hep A, Dite P
Interní gastroenterologická klinika Lékarské fakulty MU a FN Brno.
Vnitr Lek. 2005 Dec;51(12):1341-50.
Gastroesophageal reflux disease (GERD) is one of the most common diseases affecting upper gastrointestinal tract. It is a chronic disease, whith stadily growing incidence and prevalence in west countries during last 30 years. GERD is caused by pathologic gastroesophageal reflux (GER). GERD includes endoscopically positive, endoscopically negative and extraesophageal reflux disease. Extraesophageal symptoms of GERD have been of a growing attention and discussion during last few years. The most discussed topics are the relation of GERD and bronchial asthma (BA), chronic cough and symptomatology from ear, nose and throught (ENT) regions, but also non - cardial chest pain and many others.
In our clinic we ran a 5 years study which aim was to evaluate the presence of GERD in patients with bronchial asthma, chronic cough and affections from ENT regions. To assess if 3 months GERD treatment would improve lung function, subjective complaints (cough) and GERD control in asthmatics; if this treatment would allow to step - down with antiasthma medication. To assess if 3 months GERD treatment can improve objective and subjective assessments in patients with chronic cough and findings in ENT regions. As for GERD, we evaluated the improvement of pH and subjective complaints (pyrosis).
We examined 86 patients with different severity of bronchial asthma, 54 patients with chronic cough and 31 patients with ENT symptoms. All patients underwent 24 hour esophageal pH metry, spirometry with lung function evaluation and objective ENT examination by flexible laryngoscopy. In case of pathologic finding on 24 hour pH-metry 3 months full antireflux treatment with proton pump inhibitors (PPI) and prokinetics was introduced. After 3 months of GERD treatment we performed control 24 hour esophageal pH metry, control spirometry and ENT examination by flexible laryngoscopy. Patients were asked to make their subjective symptoms assessments.
We found that GERD prevalence in patients with respiratory symptoms was very high. Three months GERD treatment improved lung function (FEV1) with statistical significance (p = 0.0319), and so improved GERD control (in 60.7% of patients with high statistical significance p = 0.0009). Subjective complaints (cough) also improved in most patients. 3 months GERD treatment did not allow to step down with maintenance BA therapy according to GINA guidelines, but it enabled to decrease the rescue medications in 50% of patients. Patients with chronic cough can benefit from GERD treatment as cough improved in 75.8% of patients.
Objective findings as well as subjective complaints improved in 75% of patients with ENT symptomatology. GERD control (DeMeester score and pyrosis if present) was highly statistically significant in all three groups of patients. It is necessary to mention, that there is a high presence of nocturnal acid breakthrough (NAB) in patients with respiratory symptoms: 30.3 % in patients with bronchial asthma, 63.6 % in patients with chronic cough and 45 % of patients with ENT manifestations.
胃食管反流病（GERD）是影响上消化道的最常见疾病之一。它是一种慢性病，在过去30年里西方国家的发病率和患病率稳步上升。GERD由病理性胃食管反流（GER）引起。GERD包括内镜阳性、内镜阴性和食管外反流病。近年来，GERD的食管外症状受到越来越多的关注和讨论。讨论最多的话题是GERD与支气管哮喘（BA）、慢性咳嗽以及耳、鼻、喉（ENT）区域症状之间的关系，还有非心源性胸痛等诸多问题。
在我们诊所进行了一项为期5年的研究，旨在评估支气管哮喘、慢性咳嗽和ENT区域疾病患者中GERD的存在情况。评估3个月的GERD治疗是否能改善哮喘患者的肺功能、主观症状（咳嗽）以及GERD控制情况；此治疗是否能减少哮喘药物用量。评估3个月的GERD治疗能否改善慢性咳嗽患者的客观和主观评估以及ENT区域的检查结果。对于GERD，我们评估pH值的改善情况和主观症状（烧心）。
我们检查了86例不同严重程度的支气管哮喘患者、54例慢性咳嗽患者和31例有ENT症状的患者。所有患者均接受24小时食管pH监测、肺功能评估的肺活量测定以及通过可弯曲喉镜进行的客观ENT检查。如果24小时pH监测有病理发现，则采用质子泵抑制剂（PPI）和促动力药进行3个月的全抗反流治疗。GERD治疗3个月后，我们进行对照24小时食管pH监测、对照肺活量测定以及通过可弯曲喉镜进行的ENT检查。要求患者进行主观症状评估。
我们发现有呼吸道症状的患者中GERD患病率非常高。3个月的GERD治疗使肺功能（FEV1）有统计学意义的改善（p = 0.0319），GERD控制情况也有改善（60.
