Ramon P, Mallart-Voisin A, Wallaert B, Boudoux L, Marchandise X, Steinling M, Ballester L, Tonnel A B
Rev Mal Respir. 1985;2(5):289-94.
This study was carried out on 104 patients of whom 94 were asthmatic and 10 patients presented with a spasmodic intractable cough; all presented with symptoms evocative of an associated gastro-oesophageal reflux (RGO). The clinical symptoms revealed a nocturnal cough (67%), cough preceeding asthma (46%) and heartburn in 60%. The asthma was severe (type III and IV in 89% of cases), or dependent on corticosteroids (37% of cases). pH monitoring of the oesophagus is the most sensitive examination (88% with positive results) slightly ahead of manometry and scintigraphy (both 81%), these examinations were clearly superior to radiographic examination (49%) and oesophageal fibroscopy (36%). The combination of pH monitoring and of scintigraphy enabled 98% of RGO cases to be identified by their clinical data. Medical treatment with Tagamet, Gaviscon and Primperan (alone or in combination) produced an improvement in the respiratory symptoms in 50% of the cases. Of the 14 surgically treated, 7 obtained an improvement in their respiratory symptoms. Seven of the ten patients with spasmodic cough were improved by medical treatment. Our study shows the frequency of oesophageal reflux in patients with severe asthma. In half of them RGO intervened as an aggravating factor and the medical treatment of RGO led to a clear improvement in the respiratory symptoms.
本研究对104例患者进行，其中94例为哮喘患者，10例表现为痉挛性顽固性咳嗽；所有患者均有提示存在胃食管反流（RGO）的症状。临床症状包括夜间咳嗽（67%）、哮喘发作前咳嗽（46%）以及烧心（60%）。哮喘病情严重（89%的病例为III型和IV型），或依赖皮质类固醇治疗（37%的病例）。食管pH监测是最敏感的检查（阳性结果占88%），略优于测压法和闪烁扫描法（均为81%），这些检查明显优于放射检查（49%）和食管纤维镜检查（36%）。pH监测与闪烁扫描法相结合，能根据临床数据识别出98%的RGO病例。使用泰胃美、胃仙-U和普瑞博思进行药物治疗（单独或联合使用），50%的病例呼吸道症状得到改善。在接受手术治疗的14例患者中，7例呼吸道症状得到改善。10例痉挛性咳嗽患者中有7例经药物治疗后病情改善。我们的研究表明，重度哮喘患者中胃食管反流的发生率较高。其中一半患者的RGO是加重因素，对RGO进行药物治疗可使呼吸道症状明显改善。
