McDonnell Melissa J, Hunt Eoin B, Ward Chris, Pearson Jeffrey P, O'Toole Daniel, Laffey John G, Murphy Desmond M, Rutherford Robert M
Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.
Lung Biology Group, National University of Ireland, Galway, Ireland.
ERJ Open Res. 2020 Nov 10;6(4). doi: 10.1183/23120541.00190-2019. eCollection 2020 Oct.
The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies.
在气道反流模式中，慢性呼吸道疾病与反流性疾病之间的相互关系极为复杂，目前仍未得到充分阐明。据报道，反流性疾病会导致或加重多种呼吸道疾病，包括喉部疾病、鼻窦炎、慢性咳嗽、哮喘、慢性阻塞性肺疾病（COPD）、特发性肺纤维化、囊性纤维化、支气管扩张以及肺移植后闭塞性细支气管炎。现在人们认识到，反流性疾病并非仅仅由胃酸反流引起，而是由于多种不同机制，源自胃和十二指肠的各种化学反流物所致。反流性疾病的诊断可能具有挑战性，尤其是要证明其在直接呼吸道上皮损伤病因中的作用。近年来，随着我们认识的增加，食管评估和胃生物标志物方面取得了重大进展。对于反流性疾病，有多种治疗方法可供选择，包括药物治疗和手术治疗，但缺乏大型随机试验来评估它们在慢性呼吸道疾病背景下的疗效。然而，日常临床实践告诉我们，反流性疾病治疗失败很常见。本临床综述总结了慢性呼吸道疾病背景下反流性疾病之间的关联，并审视了有关潜在治疗策略的现有证据。
