Bongiovanni Annarita, Parisi Giuseppe F, Scuderi Maria G, Licari Amelia, Brambilla Ilaria, Marseglia Gian L, Leonardi Salvatore
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
Minerva Pediatr. 2019 Dec;71(6):515-523. doi: 10.23736/S0026-4946.19.05531-2. Epub 2019 May 23.
Gastro-esophageal reflux disease (GERD) indicates a gastroesophageal reflux that causes symptoms such as pain, and needs medical therapy, and may result in complications such as erosive esophagitis, aspiration pneumonia. Here, we review if it exists a real link between clinical presentation of some respiratory diseases such as asthma, chronic cough, cystic fibrosis and laryngopharyngitis and GERD.
This review was conducted employing 2 databases: PubMed and Science Direct.
Asthma may lead to reflux, and reflux could exacerbate asthma or cause asthma-like symptoms. Prevalence of GERD in children with asthma ranged from as low 32% to as high 80%. There are several studies where the use of proton pump inhibitors (PPIs) and histamine H2 receptor antagonists lead to inconclusive results. The relation of chronic unexplained cough to GERD remains controversial in children and pediatric guidelines do not currently recommend empirical GERD treatment trials for pediatric chronic cough. Gastroesophageal reflux is more frequent in patients with cystic fibrosis (CF) than general population. Although PPIs are regularly prescribed in approximately half of the patients with CF, there are no specific guidelines for treatment of reflux in CF and it was shown that chronic treatment with PPIs was correlated to possible increased risk of exacerbations.
The pathogenesis of GER-related respiratory symptoms is multifactorial. The causal relationship between these two conditions may be difficult to prove also with the aid of supporting tests. Multichannel intraluminal impedance associated with pH-metry (pH/MII) detect all gastroesophageal reflux episodes accompanied with a bolus movement and classify GER episodes according to their content (liquid, gas and mixed), pH value and proximal extension. There are no consistent evidences confirming the validity of medical therapy in reflux with respiratory symptoms.
胃食管反流病（GERD）是指胃食管反流引起疼痛等症状，需要药物治疗，并可能导致诸如糜烂性食管炎、吸入性肺炎等并发症。在此，我们探讨一些呼吸系统疾病，如哮喘、慢性咳嗽、囊性纤维化和喉咽炎的临床表现与GERD之间是否存在真正的联系。
本综述使用了两个数据库进行：PubMed和科学Direct。
哮喘可能导致反流，而反流可能会加重哮喘或引发类似哮喘的症状。哮喘患儿中GERD的患病率低至32%，高至80%。有几项研究表明，使用质子泵抑制剂（PPI）和组胺H2受体拮抗剂的结果尚无定论。儿童慢性不明原因咳嗽与GERD的关系仍存在争议，儿科指南目前不建议对儿童慢性咳嗽进行经验性GERD治疗试验。囊性纤维化（CF）患者的胃食管反流比普通人群更常见。尽管约一半的CF患者经常使用PPI，但目前尚无CF反流治疗的具体指南，并且有研究表明，长期使用PPI可能会增加病情加重的风险。
GER相关呼吸道症状的发病机制是多因素的。这两种情况之间的因果关系可能也难以通过辅助检查来证明。多通道腔内阻抗联合pH监测（pH/MII）可检测所有伴有团块运动的胃食管反流事件，并根据其内容物（液体、气体和混合）、pH值和近端延伸对GER事件进行分类。没有一致的证据证实药物治疗对有呼吸道症状的反流的有效性。
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