Coughran Alanna, Balakrishnan Karthik, Ma Yifei, Vaezeafshar Reza, Capdarest-Arest Nicole, Hamdi Osama, Sidell Douglas R
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.
Department of Otorhinolaryngology and Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2021 Jan;131(1):209-217. doi: 10.1002/lary.28544. Epub 2020 Feb 10.
The mechanism by which recurrent croup occurs is unknown. Gastroesophageal reflux is commonly implicated, although this relationship is only loosely documented. We conducted a systematic review with a meta-analysis component to evaluate the relationship between recurrent croup and gastroesophageal reflux disease (GERD), and to assess for evidence of improvement in croup symptoms when treated.
Systematic Review and Meta Analysis.
We searched five separate databases. Studies were included if they discussed the relationship between croup and GERD in children, >5 subjects, and available in English. Literature retrieved was assessed according to pre-specified criteria. Retrieved articles were reviewed by two independent authors and decisions mediated by a third author. If there was a difference of opinion after first review, a second review was performed to obtain consensus. Heterogeneity was calculated and summarized in forest plots.
Of 346 initial records, 15 met inclusion criteria. These were two retrospective cohort and 13 cross-sectional studies. Thirteen of 15 articles support an association between recurrent croup and GERD. Although heterogeneity is high among studies that reported prevalence of GERD, there is less uncertainty in results for improvement to recurrent croup after GERD treatment. Most studies lacked a control group and all carry a moderate-to-high risk of bias.
There is limited evidence linking GERD to recurrent croup; Further research is needed to assess for causality as most studies are retrospective, lack a control group, and have a study design exposing them to bias. Patients treated with reflux medication appear to demonstrate a reduced incidence of croup symptoms.
1 Laryngoscope, 131:209-217, 2021.
复发性喉炎的发病机制尚不清楚。胃食管反流常被认为与之有关，尽管这种关系仅有不充分的文献记载。我们进行了一项包含荟萃分析的系统评价，以评估复发性喉炎与胃食管反流病（GERD）之间的关系，并评估治疗后喉炎症状改善的证据。
系统评价和荟萃分析。
我们检索了五个独立的数据库。纳入的研究需讨论儿童喉炎与GERD之间的关系、受试者超过5名且为英文文献。根据预先设定的标准对检索到的文献进行评估。检索到的文章由两位独立作者进行评审，分歧由第三位作者协调。如果初次评审后存在意见分歧，则进行二次评审以达成共识。计算异质性并在森林图中进行总结。
在346条初始记录中，15条符合纳入标准。其中有两项回顾性队列研究和13项横断面研究。15篇文章中有13篇支持复发性喉炎与GERD之间存在关联。尽管报告GERD患病率的研究之间异质性较高，但GERD治疗后复发性喉炎改善结果的不确定性较小。大多数研究缺乏对照组，且均存在中到高度的偏倚风险。
将GERD与复发性喉炎联系起来的证据有限；由于大多数研究是回顾性的，缺乏对照组，且研究设计存在偏倚风险，因此需要进一步研究以评估因果关系。接受反流药物治疗的患者似乎喉炎症状发生率降低。
1 喉镜，131:209 - 217，2021年。
