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麻荣武 《实用心脑肺血管病杂志》2009,17(7):594-595
目的探讨胃食管反流病误诊原因,提出防范误诊措施。方法对48例胃食管反流病误诊资料进行回顾性分析。结果48例患者主要表现为咽痛、清咽、咽部阻塞感、咽不适感等胃肠外症状。喉镜检查均见咽喉部黏膜充血、水肿、咽后壁有淋巴小结增生。经胃镜检查、诊断性治疗诊断胃食管反流病。给予质子泵抑制剂及促胃动力药。结论部分胃食管反流病以咽喉症状为主要表现,易误诊为咽喉疾病,应仔细鉴别胃食管反流病,行胃镜检查或24h食管PH值测定及其他寻找胃食管反流证据的检查、给予质子泵抑制剂诊断性治疗,有助于正确诊断。 相似文献
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胃食管反流病(GERD)是胃十二指肠内容物反流入食管产生的症状和并发症。它可以引起反流、烧心、胸痛等症状,并可导致食管和食管以外的咽、喉、气管等组织损害,表现为咽喉炎、哮喘、咳嗽或胸痛等。胃食管反流(GER)引起的胸痛特别是持续性胸骨后疼痛并放射至颈部等时酷似心绞痛容易误诊。现就GERD误诊为心绞痛15例患者的资料分析如下。 相似文献
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胃食管反流病(gastroesophageal reflux disease,GERD)是由胃内容物反流引起不适症状和(或)并发症的一种疾病,包括食管内症状与食管外症状.胃食管反流性咳嗽(gastroesophageal reflux cough,GERC)是临床上引起不明原因慢性咳嗽的重要病因之一,有18.6%-41.1%不明原因的慢性咳嗽与胃食管反流相关.临床中本病的发生较为常见,但却容易被误诊误治。笔者通过查询近十年中国知网关于GERC中西医治疗的临床研究,对其进行综述,以期为今后治疗本病及对其进一步的研究提供参考。 相似文献
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��������θʳ�ܷ������������Ƶ��о� 总被引:9,自引:0,他引:9
目的探讨非糜烂性胃食管反流病不同于反流性食管炎的发病机制。方法选择1996~2004年北京大学人民医院因反酸、胃灼热感等反流症状确诊为胃食管反流病患者57例,按照内镜下食管黏膜有无破损分为非糜烂性胃食管反流病组和反流性食管炎组,比较两组的一般情况、反流症状、是否合并H.pylori(Hp)感染,以及食管动力测定和食管胃24hpH监测结果。结果两组患者年龄、性别、烟酒嗜好等一般情况及合并Hp感染情况比较差异无显著性。非糜烂性胃食管反流病组不典型反流症状(胸骨后痛)的发生率明显高于反流性食管炎组。两组患者都存在病理性酸反流,但两组患者之间酸和(或)碱反流比较无差异。非糜烂性胃食管反流病患者的食管体部各段蠕动波峰值明显高于反流性食管炎患者。非糜烂性胃食管反流病患者卧位胃酸分泌高于反流性食管炎患者。结论非糜烂性胃食管反流病的不典型反流症状发生率更高。在两组发病机制异同上,反流的强弱并非主要因素,重要的是食管防御机制的差别。 相似文献
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米本义 《实用心脑肺血管病杂志》2008,16(10)
胃食管反流病(GERD)是胃十二指肠内容物反流入食管产生的症状和并发症。它可以引起反流、胃灼热、胸痛等症状,并可导致食管和食管以外的咽、喉、气管等组织损害,表现为咽喉炎、哮喘、咳嗽或胸痛等。GERD引起的胸痛特别是持续性胸骨后疼痛并放射至颈部等时似心绞痛容易误诊。现就我科2000年5月—2007年10月将GERD误诊为心绞痛的11例患者临床资料分析如下。 相似文献
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Stephen K. Field 《The Journal of asthma》1999,36(8):631-644
The relationship between asthma and gastroesophageal reflux (GER) is controversial. This paper reviews the evidence for an association between them, the effect of asthma on GER, and the effects of GER and antireflux therapy on asthma. The association between the two conditions seems firm but studies of the effects of GER on asthma and asthma on GER are contradictory. Critical review suggests that GER affects asthma symptoms but not pulmonary function. Antireflux therapy improves asthma symptoms and reduces medication requirements but does not improve pulmonary function. The paradox of GER causing asthma symptoms but not changing pulmonary function may be explained by its increasing minute ventilation rather than triggering bronchospasm. 相似文献
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Gastroesophageal reflux and unexplained chronic respiratory disease in infants and children 总被引:3,自引:0,他引:3
Thirty-eight children, aged from a few weeks to 7 years, with severe chronic pulmonary disease and without gastrointestinal symptoms, were investigated for gastroesophageal reflux (GER), using prolonged pH probe monitoring and gastroesophageal scintiscanning. All treatments were discontinued before testing. GER was found in 24 patients (63%) (group I) and it was not observed in 14 patients (group II). All patients of group I received antireflux treatment, consisting of cisapride; in 22 of 24 patients, GER was controlled, as indicated by improvement of either pH monitoring or scintiscanning, or both. Eighteen of these 22 (82%) had remission of their pulmonary disease, and only two patients of group II (14%) had spontaneous remission of the respiratory symptoms. We concluded that GER was probably the cause of the respiratory disease in 63% of our patients, since treatment of GER was followed by disappearance of the respiratory complaints in most of them. The combination of gastroesophageal scintiscanning and pH probe study improved the diagnostic accuracy. 相似文献
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During attacks of asthma, changes in the transdiaphragmatic pressure gradient may impair the antireflux barrier and provoke gastroesophageal reflux (GER). If GER triggers asthma and asthma causes GER, a vicious circle could arise with an increase in the severity of asthma symptoms. The aim of this investigation was to determine whether postprandial reflux in asthmatics with GER disease is increased during histamine-induced bronchospasm and also if theophylline increases GER during provoked episodes of bronchospasm. Ten patients with chronic asthma and pathologic GER were challenged with either histamine or saline in randomized order with and without their regular dose of oral slow-release theophylline. FEV1 was recorded at regular intervals during the hour of provocation, and acid reflux (pH less than 4) was monitored by antimony pH electrodes in the esophagus. GER was not more pronounced during the provoked bronchospasm period irrespective of theophylline treatment or not. It seems unlikely that mild bronchospasm provokes reflux in patients with asthma and GER. It would appear that mild bronchospasm is rather protective against gastroesophageal reflux. 相似文献
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Orr WC 《Reviews in gastroenterological disorders》2003,3(Z4):S22-S29
There is a burgeoning interest in the relationship between sleep-related gastroesophageal reflux (GER) and the development of esophageal and extra esophageal complications. The physiological changes associated with sleep, such as suspension of the regulation of body temperature, may influence nocturnal GER and esophageal acid clearance. Data indicate that sleep induces considerable risk of prolonged acid mucosal contact and facilitates the occurrence of proximal migration of acid, thereby increasing the probability of pulmonary aspiration. Nocturnal GER can lead to the development of esophagitis and other extra esophageal complications, such as exacerbation of asthmatic symptoms. 相似文献
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STUDY OBJECTIVES: To determine the prevalence of gastroesophageal reflux (GER) symptoms in patients with COPD and the association of GER symptoms with the severity of airways obstruction as assessed by pulmonary function tests (PFTs). DESIGN: Prospective questionnaire-based, cross-sectional analytic survey. SETTING: Outpatient pulmonary and general medicine clinics at a Veterans Administration hospital. PATIENTS: Patients with mild-to-severe COPD (n = 100) were defined based on American Thoracic Society criteria. The control group (n = 51) consisted of patients in the general medicine clinic without respiratory complaints or prior diagnosis of asthma or COPD. INTERVENTION: Both groups completed a modified version of the Mayo Clinic GER questionnaire. RESULTS: Compared to control subjects, a greater proportion of COPD patients had significant GER symptoms defined as heartburn and/or regurgitation once or more per week (19% vs 0%, respectively; p < 0.001), chronic cough (32% vs 16%; p = 0.03), and dysphagia (17% vs 4%; p = 0.02). Among patients with COPD and significant GER symptoms, 26% reported respiratory symptoms associated with reflux events, whereas control subjects denied an association. Significant GER symptoms were more prevalent in COPD patients with FEV(1) < or %, as compared with patients with FEV(1) > 50% of predicted (23% vs 9%, respectively; p = 0.08). In contrast, PFT results were similar among COPD patients with and without GER symptoms. An increased number of patients with COPD utilized antireflux medications, compared to control subjects (50% vs 27%, respectively; p = 0.008). CONCLUSIONS: The questionnaire demonstrated a higher prevalence of weekly GER symptoms in patients with COPD, as compared to control subjects. There was a trend toward higher prevalence of GER symptoms in patients with severe COPD; however, this difference did not reach statistical significance. We speculate that although GER may not worsen pulmonary function, greater expiratory airflow limitation may worsen GER symptoms in patients with COPD. 相似文献
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Rascon-Aguilar IE Pamer M Wludyka P Cury J Coultas D Lambiase LR Nahman NS Vega KJ 《Chest》2006,130(4):1096-1101
BACKGROUND AND AIMS: The impact of gastroesophageal reflux disease (GERD) on exacerbations of COPD has never been evaluated. The aims of this investigation were to determine the prevalence of gastroesophageal reflux (GER) symptoms in COPD patients and the effect of GER on the rate of exacerbations of COPD per year. METHODS: A questionnaire-based, cross sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting criteria and agreeing to participate were asked to complete the Mayo Clinic GERD questionnaire by either personal/telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Other outcome measures noted were frequency and type of COPD exacerbations. Statistical analysis was performed using the Fisher exact test for categorical data and the independent t test for interval data. RESULTS: Eighty-six patients were enrolled and interviewed (mean age, 67.5 years). Male patients accounted for 55% of the study group. Overall, 37% of patients reported GER symptoms. The mean FEV(1) percentage of predicted was similar in those with or without GER. The rate of exacerbations of COPD was twice as high in patients with GER symptoms compared to those without GER symptoms (3.2/yr vs 1.6/yr, p = 0.02). CONCLUSIONS: The presence of GER symptoms appears to be associated with increased exacerbations of COPD. 相似文献
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Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease 总被引:5,自引:0,他引:5
OBJECTIVES: Gastroesophageal reflux (GER) may underlie respiratory manifestations via vagally mediated airway hyperresponsiveness or microaspiration, and intraesophageal pH monitoring is generally used to identify GER in patients with such manifestations. We aimed to establish the frequency of retrograde pulmonary aspiration in patients with unexplained respiratory manifestations. METHODS: Fifty-one patients with refractory respiratory symptoms (cough, n = 18; pneumonia, n = 14; apnea, n = 8; asthma, n = 7; and laryngitis, n = 4) were prospectively evaluated. They underwent 24-h intraesophageal pH monitoring and gastroesophageal 99Tc scintigraphy with lung scan 18 to 20 h after the test meal. RESULTS: Thirteen of 51 patients (25.5%) had abnormal intraesophageal pH study results (mean reflux index, 11.3%; range, 6.5 to 50%); and in 25 of 51 patients (49%), overnight scintigraphy showed pulmonary aspiration. Nineteen of these 25 patients had entirely normal pH study results, whereas 6 of 13 patients with abnormal pH study results had aspiration. Pulmonary aspiration was demonstrated in all patients with apnea and 61.5% of patients with recurrent pneumonia. Nine of 25 patients (36%) with aspiration had histologic evidence of esophagitis, whereas histologic esophagitis was present in 5 of 13 patients (38.4%) with pathologic GER as shown by intraesophageal pH monitoring. CONCLUSIONS: Pulmonary aspiration as demonstrated by overnight scintigraphy is common in children with unexplained and refractory respiratory manifestations, suggesting that GER could be the underlying cause of these manifestations. Since only a few children with chronic or recurrent respiratory symptoms have a pathologic gastroesophageal acid reflux, a normal intraesophageal pH study result does not rule out GER in these children. 相似文献
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BACKGROUND: Antireflux therapy, including surgery, has been advocated for asthma patients with gastroesophageal reflux (GER). A recent review of medical antireflux therapy reported improvements in asthma symptoms and medication requirements but no improvement in pulmonary function. The purpose of this article is to review the available literature on the effects of antireflux surgery in asthma. METHOD: Using the Medline 1966 to August 1998 database, lung disease, asthma, and pulmonary function were combined with GER and different antireflux surgeries, including fundoplication. Reference lists of identified articles were also reviewed. RESULTS: Combining the terms asthma and GER identified 271 articles, including 193 in English. Searching the term fundoplication identified 497 articles, including 413 in English. Twenty-four reports addressed the effects of antireflux surgery in asthma. Only two studies were controlled. Asthmatic data could not be distinguished from that of other subjects in five articles. The remainder were case series, retrospective reviews, or uncontrolled studies. Ten reports included data on < or = 10 patients. Two studies were only published as abstracts. A total of 417 asthma patients were included in the identified reports. Antireflux surgery improved GER symptoms, asthma symptoms, asthma medication use, and pulmonary function in 90%, 79%, 88%, and 27%, respectively. CONCLUSIONS: Antireflux surgery may improve GER and asthma symptoms and decrease medication requirements, but it has little effect on pulmonary function. The effects of antireflux surgery on asthma are similar to those of medical antireflux therapy. 相似文献
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M Veyrac P Bories H Collet G Parelon P Fauroux P Godard H Michel 《Gastroentérologie clinique et biologique》1986,10(5):400-404
Fifty-five adults with asthma were explored by gastroesophageal scintigraphy (GES) and pH monitoring (3 postprandial hours, 12 nocturnal hours). For their asthma, all patients received theophylline twice a day. Associated digestive symptomatology led to investigations for gastroesophageal reflux (GER). Twelve hours pH monitoring, the reference method, was validated in 13 normal volunteers. During 12 hr pH monitoring, 4 criteria were studied: number of GER, percentage of time at pH 4, number of GER longer than 5 min and longest GER. Acid reflux occurred in 69 p. 100 of cases. Three hours postprandial pH monitoring and GES showed a GER in 40 and 47.5 p. 100 of cases (p greater than 0.05). GES revealed pulmonary aspiration in almost a quarter of asthmatic adults. Detection of a 30 p. cent increment of nocturnal GER by long pH monitoring could explain that results may differ with various techniques. Pulmonary aspiration was more frequent after longer and deeper GER. The mean duration of GER was more than 9 min but it was not significantly different from GER without pulmonary aspiration. GES may be helpful after 12 h pH monitoring because it can prove pulmonary aspiration. Its association with long and intense GER at 12 h pH monitoring suggests definitive surgical treatment of GER in asthmatic patients. 相似文献
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The Pattern of Gastroesophageal Reflux in Asthmatic Children 总被引:4,自引:0,他引:4
The association between gastroesophageal reflux (GER) and asthma is not fortuitous. The objective of our study was to test a group of children with asthma by 24 hr gastroesophageal pH monitoring and to relate the results to the patients' medical history and clinical data. We studied 77 children aged from 39 to 170 months suffering from particularly recurrent and/or therapy-resistant asthma. Medical history data were collected for each patient and included: severity and characteristics of respiratory symptoms; presence, if any, of allergy; presence, if any, of GER-related symptoms; and presence, if any, of esophagitis-related symptoms. Esophageal pH was measured by 24 hr computerized monitoring of the main measures in all patients. Forty-seven children were also examined by gastroesophageal endoscopy. The prevalence of GER was 61% on the basis of the reflux index (cutoff: 4.2%). Gastroesophageal reflux in these asthmatic children was characterized mainly by short-lasting daytime episodes. The patients tended to present GER mainly associated with vomiting but not with signs and symptoms of esophagitis. The short-lasting nature of the reflux episodes demonstrates good esophageal clearance. The time of onset of respiratory symptoms (day/night) was not associated with any particular type of GER, the severity of which tends to be proportional to the seriousness of the asthma. No correlation was found between GER and allergy. No statistically significant differences were found in clinical or medical history findings between patients with pathologic and nonpathologic GER. 相似文献