Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
JAMA Surg. 2013 Jan;148(1):50-8. doi: 10.1001/jamasurgery.2013.404.
To determine the patterns and proximity of reflux events in patients with adult-onset asthma (AOA) using hypopharyngeal multichannel intraluminal impedance (HMII) and to assess outcomes of antireflux surgery (ARS) in patients with AOA. DESIGN Retrospective review of prospectively collected data.
University hospital. PATIENTS, INTERVENTIONS, AND OUTCOMES: All patients with AOA referred to our testing center underwent HMII, and those with abnormal proximal exposure, defined as laryngopharyngeal reflux at least once a day and/or high esophageal reflux at least 5 times a day, subsequently underwent ARS.
From October 1, 2009, through June 30, 2011, a total of 31 patients with AOA (4 men and 27 women; mean age, 53 years) underwent HMII. Of 27 patients with available information, 11 (41%) had objective evidence of reflux disease. Nineteen patients (70%) had concomitant typical reflux symptoms. Despite a frequently negative DeMeester score, abnormal proximal exposure, which occurred in the upright position, was observed in 19 patients (70%). Of 20 patients who subsequently underwent ARS, asthma symptoms improved in 18 (90%), and 6 of them discontinued or reduced pulmonary medications at a mean (range) follow-up of 4.6 (0.6-15.2) months. Pulmonary function test results before and after ARS revealed that of 5 patients, 4 (80%) had improvement of the forced expiratory volume in the first second of expiration and/or the peak expiratory flow rate, which correlated with symptomatic improvement.
Adult-onset asthma is associated with abnormal proximal exposure of the aerodigestive tract to refluxate; these patients respond to ARS despite negative pH test results. Patients with AOA should undergo testing with HMII because they would not be detected with conventional pH testing.
使用下咽多通道腔内阻抗（HMII）确定成人起病哮喘（AOA）患者反流事件的模式和接近程度，并评估 AOA 患者抗反流手术（ARS）的结果。
前瞻性收集数据的回顾性分析。
大学医院。
患者、干预措施和结果：所有转诊至我们检测中心的 AOA 患者均接受 HMII 检查，对于近端暴露异常的患者（定义为至少每天一次出现喉咽反流和/或每天至少 5 次出现食管高反流），随后进行 ARS。
从 2009 年 10 月 1 日至 2011 年 6 月 30 日，共有 31 例 AOA 患者（4 名男性和 27 名女性；平均年龄 53 岁）接受了 HMII 检查。在有可用信息的 27 例患者中，有 11 例（41%）有反流性疾病的客观证据。19 例患者（70%）有典型的反流症状。尽管 DeMeester 评分常为阴性，但仍有 19 例患者（70%）观察到直立位时近端暴露异常。在随后接受 ARS 的 20 例患者中，哮喘症状改善 18 例（90%），其中 6 例在平均（范围）4.6（0.6-15.2）个月的随访中停止或减少了肺部药物治疗。ARS 前后的肺功能检查结果显示，5 例患者中有 4 例（80%）第一秒用力呼气量和/或呼气峰流速改善，这与症状改善相关。
成人起病哮喘与气道对反流物的近端暴露异常有关；尽管 pH 测试结果为阴性，但这些患者对 ARS 有反应。AOA 患者应接受 HMII 检查，因为他们不会被常规 pH 检查检测到。
