胃食管反流相关性慢性咳嗽合并喉咽反流患者的反流特征
Reflux characteristics in patients with gastroesophageal reflux-related chronic cough complicated by laryngopharyngeal reflux.
作者信息
Yu Yiming, Wen Siwan, Wang Shengyuan, Shi Cuiqin, Ding Hongmei, Qiu Zhongmin, Xu Xianghuai, Yu Li
机构信息
Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.
Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, China.
出版信息
Ann Transl Med. 2019 Oct;7(20):529. doi: 10.21037/atm.2019.09.162.
BACKGROUND
This study aimed to investigate the reflux characteristics in patients with gastroesophageal reflux-related chronic cough (GERC) complicated by laryngopharyngeal reflux (LPR).
METHODS
Patients with chronic cough were recruited. Reflux symptom index (RSI) scoring, cough symptom scoring, assessment of capsaicin cough sensitivity, and multichannel intraluminal impedance and pH monitoring (MII-pH) were performed.
RESULTS
RSI score in GERC patients was significantly higher than that in patients with atopic cough (AC), cough variant asthma, eosinophilic bronchitis (EB), and upper airway cough syndrome (UACS) (P<0.05). The RSI score in non-acid GERC patients was significantly higher than that in acid GERC patients (P=0.003). The cut-off value of the RSI score was defined as 19 during diagnosis of non-acid GERC. In the RSI ≥19 group, there was more proximal reflux and more significant gas and non-acid reflux, and the efficacy of a combined use of baclofen or gabapentin was better than that of the RSI <19 group (P<0.05). The efficacy of proton pump inhibitor (PPI) at a routine dosage together with prokinetic agents in the RSI <19 group was better than that in the RSI ≥19 group (P=0.009).
CONCLUSIONS
LPR overlaps with GERC in part. GERC patients with higher RSI scores may present more proximal reflux, non-acid reflux, and gas reflux, and get better efficacy with neuromodulators (gabapentin or baclofen) used as an add-on therapy.
背景
本研究旨在调查胃食管反流相关慢性咳嗽（GERC）合并喉咽反流（LPR）患者的反流特征。
方法
招募慢性咳嗽患者。进行反流症状指数（RSI）评分、咳嗽症状评分、辣椒素咳嗽敏感性评估以及多通道腔内阻抗和pH监测（MII-pH）。
结果
GERC患者的RSI评分显著高于特应性咳嗽（AC）、咳嗽变异性哮喘、嗜酸性粒细胞性支气管炎（EB）和上气道咳嗽综合征（UACS）患者（P<0.05）。非酸性GERC患者的RSI评分显著高于酸性GERC患者（P=0.003）。诊断非酸性GERC时，RSI评分的截断值定义为19。在RSI≥19组中，近端反流更多，气体和非酸性反流更显著，联合使用巴氯芬或加巴喷丁的疗效优于RSI<19组（P<0.05）。常规剂量质子泵抑制剂（PPI）联合促动力剂在RSI<19组中的疗效优于RSI≥19组（P=0.009）。
结论
LPR部分与GERC重叠。RSI评分较高的GERC患者可能出现更多的近端反流、非酸性反流和气体反流，作为附加治疗使用神经调节剂（加巴喷丁或巴氯芬）疗效更好。
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