罗马尼亚胃食管反流病诱发的呼吸道表现诊断与治疗指南。

Romanian Guidelines for the Diagnosis and Treatment of GERD-induced Respiratory Manifestations.

作者信息

Drug Vasile Liviu, Antoniu Sabina, Oana Barboi Bogdana, Arghir Oana Cristina, Bancila Ion, Bataga Simona, Brisc Ciprian, Cijevschi-Prelipcean Cristina, Ciocîrlan Mihai, Ciortescu Irina, David Liliana, Deleanu Oana Claudia, Diculescu Mircea, Dimitriu Anca, Dobru Daniela, Dumitru Eugen, Gheonea Dan Ionut, Gheorghe Cristian, Goldis Adrian, Jinga Mariana, Man Milena, Mateescu Bogdan, Manuc Mircea, Mihai Catalina, Mihaltan Florin, Mihaescu Traian, Nedelcu Laurentiu, Negreanu Lucian, Pop Carmen Monica, Rajnoveanu Ruxandra, Saftoiu Adrian, Seicean Andrada, Sporea Ioan, Stanciu Carol, Surdea-Blaga Teodora, Tantau Marcel, Todea Doina, Trifan Anca Victorita, Ulmeanu Ruxandra, Iov Diana Elena, Dumitrascu Dan Lucian

机构信息

Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. .

Grigore T. Popa University of Medicine and Pharmacy, Iasi; Pneumology Hospital, Iasi, Romania.

出版信息

J Gastrointestin Liver Dis. 2022 Mar 19;31(1):119-142. doi: 10.15403/jgld-4196.

DOI:10.15403/jgld-4196

PMID:35306549

Abstract

BACKGROUND AND AIMS

Gastroesophageal reflux disease (GERD) is a common condition present in daily practice with a wide range of clinical phenotypes. In this line, respiratory conditions may be associated with GERD. The Romanian Societies of Gastroenterology and Neurogastroenterology, in association with the Romanian Society of Pneumology, aimed to create a guideline regarding the epidemiology, diagnosis and treatment of respiratory conditions associated with GERD.

METHODS

Delphi methodology was used and eleven common working groups of experts were created. The experts reviewed the literature according to GRADE criteria and formulated 34 statements and recommendations. Consensus (>80% agreement) was reached for some of the statements after all participants voted.

RESULTS

All the statements and the literature review are presented in the paper, together with their correspondent grade of evidence and the voting results. Based on >80% voting agreement, a number of 22 recommendations were postulated regarding the diagnosis and treatment of GERD-induced respiratory symptoms. The experts considered that GERD may cause bronchial asthma and chronic cough in an important number of patients through micro-aspiration and vagal-mediated tracheobronchial reflex. GERD should be suspected in patients with asthma with suboptimal controlled or after exclusion of other causes, also in nocturnal refractory cough which needs gastroenterological investigations to confirm the diagnosis. Therapeutic test with double dose proton pump inhibitors (PPI) for 3 months is also useful. GERD induced respiratory conditions are difficult to treat; however,proton pump inhibitors and laparoscopic Nissen fundoplication are endorsed for therapy.

CONCLUSIONS

This guideline could be useful for the multidisciplinary management of GERD with respiratory symptoms in current practice.

摘要

背景与目的

胃食管反流病（GERD）是日常临床实践中常见的疾病，具有广泛的临床表型。在这方面，呼吸系统疾病可能与GERD相关。罗马尼亚胃肠病学和神经胃肠病学学会与罗马尼亚肺病学会联合旨在制定一份关于与GERD相关的呼吸系统疾病的流行病学、诊断和治疗的指南。

方法

采用德尔菲法，成立了11个专家共同工作组。专家们根据GRADE标准对文献进行了综述，并制定了34条陈述和建议。在所有参与者投票后，部分陈述达成了共识（>80%同意）。

结果

本文呈现了所有陈述、文献综述及其相应的证据等级和投票结果。基于>80%的投票同意率，针对GERD诱发的呼吸道症状的诊断和治疗提出了22条建议。专家们认为，GERD可能通过微误吸和迷走神经介导的气管支气管反射在相当数量的患者中导致支气管哮喘和慢性咳嗽。对于哮喘控制不佳或排除其他病因后的患者，以及夜间难治性咳嗽患者，应怀疑GERD，需要进行胃肠病学检查以确诊。使用双倍剂量质子泵抑制剂（PPI）进行3个月的治疗性试验也很有用。GERD诱发的呼吸系统疾病难以治疗；然而，质子泵抑制剂和腹腔镜下尼氏胃底折叠术被认可用于治疗。