Sontag S J, Schnell T G, Miller T Q, Khandelwal S, O'Connell S, Chejfec G, Greenlee H, Seidel U J, Brand L
Department of Ambulatory Care, Veterans Administration Hospital, Hines, Illinois 60141.
Gut. 1992 Jul;33(7):872-6. doi: 10.1136/gut.33.7.872.
The exact relation between gastro-oesophageal reflux and asthma remains poorly understood. To determine whether gastro-oesophageal reflux in asthmatics results in oesophagitis, endoscopy and oesophageal biopsy were performed on 186 consecutive adult asthmatics. The presence or absence of reflux symptoms was not used as a selection criterion for asthmatics. Endoscopy was performed by two endoscopists using predefined criteria. All asthmatics had discrete wheezing and either a previous diagnosis of asthma or documented reversible airways obstruction of at least 20%. The oesophageal mucosa was graded as normal if no erosions or ulcerations were present in the tubular oesophagus; as oesophagitis if a mucosal break with exudate (erosions and/or ulcerations) was present; and as Barrett's if specialised (intestinal) columnar epithelium was present. A hiatal hernia was diagnosed if greater than or equal to 2 cm of gastric mucosa appeared above the diaphragm during endoscopy. Thirty nine per cent of the patients with asthma had oesophagitis or Barrett's oesophagus, or both. There was no difference in the oesophageal mucosal status between asthmatics who required and those who did not require bronchodilators. Fifty eight per cent of asthmatics had a hiatal hernia. It is concluded that oesophagitis is common and independent of the use of bronchodilator therapy in asthmatics.
胃食管反流与哮喘之间的确切关系仍未得到充分理解。为了确定哮喘患者的胃食管反流是否会导致食管炎，对186例连续的成年哮喘患者进行了内镜检查和食管活检。是否存在反流症状未被用作哮喘患者的选择标准。由两名内镜医师按照预先确定的标准进行内镜检查。所有哮喘患者均有明确的喘息，且既往有哮喘诊断或记录到至少20%的可逆性气道阻塞。如果管状食管未出现糜烂或溃疡，则食管黏膜分级为正常；如果存在伴有渗出物的黏膜破损（糜烂和/或溃疡），则分级为食管炎；如果存在特殊的（肠型）柱状上皮，则分级为巴雷特食管。如果在内镜检查期间膈上出现大于或等于2 cm的胃黏膜，则诊断为食管裂孔疝。39%的哮喘患者患有食管炎或巴雷特食管，或两者皆有。需要使用支气管扩张剂和不需要使用支气管扩张剂的哮喘患者之间的食管黏膜状态没有差异。58%的哮喘患者有食管裂孔疝。得出的结论是，食管炎在哮喘患者中很常见，且与支气管扩张剂治疗的使用无关。
