Ojeda Casas J A, García Ara M C, Martín Muñoz F, Díaz Pena J M, Añibarro Bausera B, Escobar Castro H
Hospital Infantil La Paz, Madrid.
An Esp Pediatr. 1990 Oct;33(4):325-33.
Over one half of the cases of chronic severe childhood asthma, refractory to conventional therapy and without other over aetiology, are associated to gastroesophageal reflux (GER). The aetiopathogenic role of GER in asthma is uncertain, and is only confirmed when therapy of the former induces evident improvement of the latter. We have instituted medical antireflux therapy over two years in 17 patients (17.6%) became asymptomatic after less than three months of therapy, and a further four (23.5%) by the sixth month. Seven patients showed clinical improvement by the third month (41%) and even a greater one by the sixth month, only very slight symptoms persisting thereafter. In three cases (17.6%) there was no improvement after two years of outcome of asthma and the persistence or not of pathological between the outcome of asthma and the persistence or not of pathological 24-hour pHmetry. On the contrary. macroscopic oesophagitis disappeared in the cases of asthma with good outcome, but persisted in all the cases who remained symptomatic. In conclusion, we consider that medical management of GER associated to asthma should be maintained for at least six months (if the clinical course so permits) before considering a surgical indication.
超过一半的慢性重度儿童哮喘病例，对传统治疗无效且无其他病因，与胃食管反流（GER）有关。GER在哮喘中的发病机制尚不确定，只有当前者的治疗能使后者明显改善时才得到证实。我们对17例患者进行了两年的药物抗反流治疗，17.6%（3例）的患者在治疗不到三个月后无症状，另有4例（23.5%）在第六个月时无症状。7例患者在第三个月时临床症状改善（41%），到第六个月时改善更明显，此后仅持续非常轻微的症状。3例患者（17.6%）在两年治疗后哮喘无改善，哮喘的转归与24小时食管pH监测结果是否存在病理性改变无关。相反，哮喘转归良好的病例中宏观食管炎消失，但在所有仍有症状的病例中持续存在。总之，我们认为与哮喘相关的GER的药物治疗应至少维持六个月（如果临床病程允许），再考虑手术指征。
