Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia.
Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
Esophagus. 2023 Jan;20(1):170-177. doi: 10.1007/s10388-022-00953-2. Epub 2022 Oct 6.
The outcome of anti-reflux surgery in patients with suspected gastro-oesophageal reflux-induced cough is frequently uncertain. The aims of this study were to assess the efficacy of laparoscopic fundoplication for controlling cough in patients with chronic cough without asthma, who have pathologic gastro-oesophageal reflux, and to identify predictors of response.
From a prospective database of 1598 patients who have undergone laparoscopic fundoplication, 66 (4%) with proven gastro-oesophageal reflux disease (GORD) and chronic cough without asthma were studied. All patients underwent gastroscopy and 24-h pH monitoring before operation. Heartburn and regurgitation were assessed using a modified DeMeester score. Severity of cough before and after surgery was self-assessed by the patient using a visual analog scale at a minimum of 12 months post-operatively (median 43 mo; range: 14-104 mo). Patients were considered to have responded to fundoplication if they had no cough or the cough had improved by 50% or more after operation.
Cough and heartburn/regurgitation were relieved in 61% (40/66) and 90% (44/49) of the patients, respectively. The presence of typical GORD symptoms or oesophagitis, and pH study variables did not predict the response of the cough to fundoplication.
Refinement in the aetiological diagnosis of chronic cough due to GORD is necessary for improved outcome. Patients diagnosed with GORD-related chronic cough need to be counseled regarding their expectations from anti-reflux surgery.
怀疑胃食管反流引起咳嗽的患者进行抗反流手术后的结果常常不确定。本研究旨在评估腹腔镜胃底折叠术治疗无哮喘的慢性咳嗽、病理性胃食管反流患者咳嗽的疗效，并确定其反应的预测因子。
从接受腹腔镜胃底折叠术的 1598 例患者的前瞻性数据库中，选择 66 例（4%）经证实患有胃食管反流病（GORD）和无哮喘的慢性咳嗽患者进行研究。所有患者在术前均接受胃镜检查和 24 小时 pH 监测。烧心和反流采用改良的 DeMeester 评分进行评估。术后至少 12 个月（中位数 43 个月；范围：14-104 个月），患者使用视觉模拟量表自行评估手术前后咳嗽的严重程度。如果患者术后无咳嗽或咳嗽改善 50%或以上，则认为对胃底折叠术有反应。
咳嗽和烧心/反流分别在 61%（40/66）和 90%（44/49）的患者中得到缓解。典型 GORD 症状或食管炎的存在以及 pH 研究变量并不能预测咳嗽对胃底折叠术的反应。
需要对 GORD 引起的慢性咳嗽的病因学诊断进行精细化，以提高疗效。被诊断为 GORD 相关慢性咳嗽的患者需要对其对反流手术的预期进行咨询。
