Sontag S J, O'Connell S, Khandelwal S, Miller T, Nemchausky B, Schnell T G, Serlovsky R
Department of Ambulatory Care, Veterans Administration Hospital, Hines, Illinois.
Gastroenterology. 1990 Sep;99(3):613-20. doi: 10.1016/0016-5085(90)90945-w.
The relationship between gastroesophageal reflux and asthma has not been clearly defined. We measured the lower esophageal sphincter pressures and studied gastroesophageal reflux patterns over 24 hours using an ambulatory Gastroreflux Recorder (Del Mar Avionics, Irvine, CA) in 44 controls and 104 consecutive adult asthmatics. The presence or absence of reflux symptoms was not used as a selection criterion for asthmatics. All asthmatics had discrete episodes of diffuse wheezing and documented reversible airway obstruction of at least 20%. Patients underwent reflux testing while receiving, if any, their usual asthmatic medications: 71.2% required chronic bronchodilators and 28.8% required no bronchodilators. Compared with controls, asthmatics had significantly decreased lower esophageal sphincter pressures, greater esophageal acid exposure times, more frequent reflux episodes, and longer clearance times in both the upright and supine positions (P less than 0.0001 for all parameters tested). There were no differences in any of the measured reflux parameters between asthmatics who required bronchodilators and those who did not. Thus, the decreased lower esophageal sphincter pressures and increased levels of acid reflux in asthmatics were not entirely caused by the effects of bronchodilator therapy. Receiver-operating characteristic analysis generated reflux values that discriminated asthmatics from controls. More than 80% of adult asthmatics have abnormal gastroesophageal reflux. We conclude that most adult asthmatics, regardless of the use of bronchodilator therapy, have abnormal gastroesophageal reflux manifested by increased reflux frequency, delayed acid clearance during the day and night, and diminished lower esophageal sphincter pressures.
胃食管反流与哮喘之间的关系尚未明确界定。我们使用动态胃反流记录仪（德尔玛航空电子公司，加利福尼亚州欧文市）测量了44名对照者和104名连续入选的成年哮喘患者的食管下括约肌压力，并研究了他们24小时的胃食管反流模式。哮喘患者是否存在反流症状不作为入选标准。所有哮喘患者均有弥漫性喘息的离散发作，并有记录显示气道可逆性阻塞至少达20%。患者在接受常规哮喘药物治疗（若正在用药）的情况下接受反流测试：71.2%的患者需要长期使用支气管扩张剂，28.8%的患者不需要使用支气管扩张剂。与对照者相比，哮喘患者的食管下括约肌压力显著降低，食管酸暴露时间更长，反流发作更频繁，直立位和仰卧位的清除时间均更长（所有测试参数P均小于0.0001）。需要支气管扩张剂的哮喘患者与不需要支气管扩张剂的哮喘患者在任何测量的反流参数上均无差异。因此，哮喘患者食管下括约肌压力降低和酸反流水平升高并非完全由支气管扩张剂治疗的影响所致。受试者工作特征分析得出了区分哮喘患者与对照者的反流值。超过80%的成年哮喘患者存在异常胃食管反流。我们得出结论，大多数成年哮喘患者，无论是否使用支气管扩张剂治疗，均存在异常胃食管反流，表现为反流频率增加、昼夜酸清除延迟以及食管下括约肌压力降低。
