Filiaci F, Zambetti G, Luce M, Lo Vecchio A, Docimo M, Romeo R
Department of Otolaryngology, University of Rome La Sapienza, Italy.
Allergol Immunopathol (Madr). 1997 Nov-Dec;25(6):266-71.
An association between asthma and gastro-esophageal reflux (GER) is well recognized but the underlying mechanism is still unclear. The authors suggest that could exist an association between GER and upper airways hyperreactivity and this association could represents the mechanism underlying the lower esophageal sphincter releasing, that determine the reflux. In fact they suppose that, the noxious injury of acid reflux follows a course that could be: pharynx-->larynx-->bronchi-->1/3 inferior of the esophagus-->reflux. From these presuppositions the authors carried out a study on the possible relationship between GER and non-specific hyperreactivity of upper airways on 14 subjects, divided in 2 groups: 10 subjects with functional GER, 4 subjects suffering from GER caused by hiatus hernia as control group. All patients had a thorough medical history, ENT examination with rigid and flexible endoscope, anterior Rhinomanometry (RRM), skin-test for inhalant and alimentary allergens, RAST, audiometric exam, non-specific nasal provocation test (NSNPT) with histamine, using as control the number of sneezes. From a through analysis of objective examination and from the results of the NSNPT with histamine resulted that all subjects with functional GER were rhinopathics. In all tests both in vivo (Skin-test) and in vitro(RAST) for the most common allergens (pollens-inhalant-mycophites-alimentary) the results were negative. The authors also found an involvement of paranasal sinuses that raised: 91% in the patients with recurrents phlogosis due to non specific nasal hyperreactivity; 40.9% in the allergic subjects (20% in the Graminacee +; 32% in the Parietaria O. +; 76% in the Dermatophagoides Pt. +; others 4%); 100% in the ASA-intolerance subjects. The NSNSPT with histamine showed in the group with functional GER a hyperreactivity with sneezes in 6/10 subjects, and 1/4 subjects of the group with GER with hiatus hernia. The RRM variations showed an unilateral nasal hyperreactivity in 6/10, bilateral in 3/10 subjects of the group with functional GER. In the group with GER with hiatus hernia only 1/4 subject showed reliable unilateral RRM variation. From the analysis of data resulted that subjects with functional GER showed a completely involvement of the upper airways and not only of the pharynx and larynx, caused by non specific hyperreactivity at the NSNPT with histamine, associated with a chronic pathology.
哮喘与胃食管反流（GER）之间的关联已得到充分认识，但其潜在机制仍不清楚。作者认为，GER与上呼吸道高反应性之间可能存在关联，这种关联可能代表了导致反流的下食管括约肌松弛的机制。事实上，他们推测，胃酸反流的有害损伤过程可能是：咽部→喉部→支气管→食管下1/3→反流。基于这些假设，作者对14名受试者进行了一项关于GER与上呼吸道非特异性高反应性之间可能关系的研究，分为两组：10名功能性GER患者，4名因食管裂孔疝引起GER的患者作为对照组。所有患者都有详尽的病史，接受了耳鼻喉科的硬性和软性内窥镜检查、前鼻测压（RRM）、吸入性和食物过敏原皮肤试验、放射性变应原吸附试验（RAST）、听力检查、用组胺进行的非特异性鼻激发试验（NSNPT），以打喷嚏次数作为对照。通过对客观检查结果的全面分析以及组胺NSNPT的结果发现，所有功能性GER患者均患有鼻病。在针对最常见过敏原（花粉 - 吸入性 - 霉菌 - 食物）的所有体内（皮肤试验）和体外（RAST）试验中，结果均为阴性。作者还发现鼻窦受累情况有所增加：因非特异性鼻高反应性导致反复炎症的患者中为91%；过敏患者中为40.9%（禾本科植物 + 中为20%；墙草属O. + 中为32%；粉尘螨Pt. + 中为76%；其他为4%）；阿司匹林不耐受患者中为100%。组胺NSNSPT显示，功能性GER组中有6/10的受试者出现打喷嚏高反应性，食管裂孔疝GER组中有1/4的受试者出现。RRM变化显示，功能性GER组中有6/10的受试者出现单侧鼻高反应性，3/10的受试者出现双侧鼻高反应性。在食管裂孔疝GER组中，只有1/4的受试者出现可靠的单侧RRM变化。数据分析结果显示，功能性GER受试者的上呼吸道完全受累，不仅是咽部和喉部，这是由组胺NSNPT时的非特异性高反应性引起的，且与一种慢性病理状况相关。
