慢性阻塞性肺病患者胃酸、幽门螺杆菌、胃食管反流的相关研究

目的探讨慢性阻塞性肺病患者幽门螺杆菌（Hp）感染、空腹胃酸、胃食管反流情况及其关系。方法对COPD患者进行胃镜检查、空腹胃酸及Hp检测，并与慢性浅表性胃炎患者对照分析。结果慢性阻塞性肺病组的感染率低于对照组（P〈0．05）；空腹胃酸高于对照组（P〈0．05）；反流性食管炎发生率高于对照组（P〈0．01）。结论根除可能与胃食管反流发生有相关性；胃食管反流与慢性咳喘有相关性。对有胃食管反流的慢性阻塞性肺病者适当应用抑酸药和胃动力药可能部分缓解症状，减少重症患者消化道出血发生率、降低病死率。     

慢性阻塞性肺疾病稳定期、急性加重期胃食管反流情况观察

为探讨慢性阻塞性肺疾病(慢阻肺)患者与胃食管反流病(GERD)的情况,我们对84例慢阻肺患者进行24小时食管pH监测以及胃食管反流症状评分,发现慢阻肺患者存在合并胃食管反流病,其严重程度与临床分期相关。     

地尔硫卓治疗慢性阻塞性肺病合并心房颤动的疗效观察

目的观察地尔硫卓治疗慢性阻塞性肺病急性发作合并心房颤动患者中的疗效。方法将128例慢性阻塞性肺病急性发作合并心房颤动患者随机分为两组。对照组64例,按照慢性阻塞性肺病常规治疗,使用胺碘酮治疗。干预组64例,在慢性阻塞性肺病常规治疗的基础上,使用地尔硫卓治疗。结果干预组心室率控制的例数明显多于对照组(χ2=26.33,P<0.05);对照组转复为窦性心律的患者明显少于干预组(χ2=10.63,P<0.05)。结论地尔硫卓治疗慢性阻塞性肺病急性发作合并心房颤动患者中的效果优于胺碘酮。     

抗反流治疗联合噻托溴铵对慢性阻塞性肺病伴胃食管反流病的临床疗效

目的:探讨抗反流治疗联合噻托溴铵对伴有胃食管反流的慢性阻塞性肺病(chonic obstructive pulmonary disease,COPD)患者的临床疗效.方法:选取2014-01/2014-12在沧州和平医院就诊的48例COPD合并胃食管反流病(gastroesophageal reflux disease,GERD)患者作为研究对象,随机分为观察组和对照组,各24例,观察组给予埃索美拉唑、莫沙必利及噻托溴铵粉吸入剂治疗,对照组单纯给予噻托溴铵粉吸入剂治疗,比较两组患者治疗前后胃食管反流病评分量表(Gastroesophageal Reflux Disease-Q,GERD-Q)评分、慢性阻塞性肺病急性发作(AECOPD)次数以及临床疗效.结果:两组患者治疗1年后,GERD-Q评分:观察组明显下降(9.83±2.65 vs 15.23±3.75,P0.001),对照组下降不显著(13.32±3.02 vs 14.98±3.64,P0.05);两组患者AECOPD次数较治疗前均下降:观察组(1.08±0.30 vs 1.59±0.34),对照组(1.33±0.31 vs 1.60±0.41).而观察组较对照组下降更明显(1.08±0.30 vs 1.33±0.31,P0.01);临床疗效:两组COPD症状改善比较(91.6%vs 87.50%,P0.05),观察组GERD症状显著优于对照组(95.83%vs 66.67%,P0.01).结论:临床中对稳定期COPD合并GEGD患者给予抗反流治疗联合噻托溴铵是可行的,可有效改善GERD-Q评分、降低AECOPD次数、临床疗效显著.     

胃食管返流对COPD急性发作中的影响

目的研究胃食管返流病在慢性阻塞性肺疾病（COPD）患者急性发作中的作用。方法对86例确诊为COPD的患者，通过面谈式回顾性调查，观察COPD患者的严重程度、COPD患者合并胃食管返流（GER）症状的病例数、抗返流治疗用药、COPD急性发作次数，我们以是否有GER症状把COPD患者分成两组，并进行统计学分析，来观察GER症状与COPD急性发作的关系。结果所有患者中37％的患者有GER。第一秒用力呼气容积（FEV1）占预计值的百分比的均值在有或无GER的患者中相似。与无GER症状的COPD相比，有GER症状的COPD患者急性发作的发生率是它的两倍。结论GER症状的流行与COPD急性发作的增加相关。     

胃食管反流病的中医治疗

近年来,我国的胃食管反流病(GERD)的发病率有逐渐增高趋势.由于胃食管反流病具有反复发作、缠绵难愈、部分患者对西药不敏感等的特点,中医对胃食管反流病的研究成为热点.     

胃食管反流病与阻塞性睡眠呼吸暂停综合征

胃食管反流病与阻塞性睡眠呼吸暂停综合征郭兮钧，郭兮华，俞亚琴，王志新，李明胃食管反流病（ＧＥＲＤ）是临床较常见疾病，有些患者常同时合并阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ，ＯＳＡＳ）。我们采用２４小时食...     

新生儿胃食管反流的临床观察及护理体会

目的研究新生儿胃食管反流的护理方法。方法对新生儿病区收治的55例患有胃食管反流的新生儿,采用洗胃、安置、抚触、体位和饮食调整以及药物相结合等综合治疗和护理。结果 55例新生儿胃食管反流次数明显减少。结论运用这种综合治疗和护理干预措施,能够有效控制并治疗新生儿的胃食管反流,从而降低胃食管反流引发并发症的发生率,有利于患儿体重的增长。     

动态心电图在以胸痛为主要表现的胃食管反流病鉴别诊断中的应用价值

目的观察多导联动态心电图在以胸痛为主要表现的胃食管反流病鉴别诊断中的应用价值。方法将55例胃食管反流病胸痛为主的患者,先后行18导联心电图及多导联动态心电图后的结果进行对比分析。结果多导联动态心电图可捕捉到更多胃食管反流胸痛发作时心电图异常表现,能客观分析病情,对临床的诊断、鉴别诊断有较大价值。结论多导联动态心电图在以胸痛为主要表现的胃食管反流病鉴别诊断中有较大的价值。     

胃食管反流病相关肺损伤与肺癌发病研究进展

正胃食管反流病(gastroesohageal reflux disease,GERD)是胃内容物反流至食管、口腔、喉及肺引起的一系列复杂症状和并发症。该病的发病率在过去20年明显增加,尤其是在北美和西亚[1]。GERD除了有反酸、烧心、吞咽困难等食管内综合征,还有可能出现慢性咳嗽、气喘等食管外综合征。胃肠道和肺在解剖结构上是相通的,GERD与哮喘、慢性阻塞性肺病(简称慢阻肺)和特发性肺纤维化(IPF)等     

Clinical implications of gastroesophageal reflux disease and swallowing dysfunction in COPD

The intimate anatomical and physiologic relationship between the upper airway and esophagus consists of complex interactions between various muscles and nerves with both voluntary and involuntary patterns of control. Alterations in this harmonic relationship can lead to swallowing abnormalities ranging from dysphagia to gross aspiration, gastroesophageal reflux disease (GERD) and chronic cough. There is a paucity of data regarding pathologic alterations in the upper airway-esophageal relationship in patients with COPD. The association between GERD and respiratory symptoms is well recognized in the setting of asthma; however, the nature of this relationship remains controversial. The association of GERD and COPD is even less clear. A review of the limited data on GERD and swallowing abnormalities in patients with COPD indicate that prevalence of GERD and esophageal disorders in patients with COPD is higher than in the normal population. However, its contribution to respiratory symptoms, bronchodilator use and pulmonary function in patients with COPD remains unknown. Although dysphagia and swallowing dysfunction on videofluoroscopic swallow evaluation are common in patients with COPD, their role as exacerbators of COPD remains to be elucidated. Further clinical research is necessary to evaluate the role of GERD and swallowing dysfunction in both stable and acute exacerbation of COPD.     

Association of gastroesophageal reflux disease risk with exacerbations of chronic obstructive pulmonary disease

Gastroesophageal reflux disease (GERD) may be a potential risk factor for exacerbations of chronic obstructive pulmonary disease (COPD). The aim of the present study was to explore the association of GERD risk with exacerbations of COPD. Patients with COPD were consecutively recruited, and COPD Assessment Test (CAT) and Reflux Diagnostic Questionnaire (RDQ) were administered. If the CAT score was 5 points higher than that taken in the stable states, the patient was considered as having exacerbations of COPD. A RDQ score of ≥12 is defined high GERD risk. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between high GERD risk and exacerbations of COPD. Among 386 patients with COPD, the mean CAT score was 18.3 ± 6.6, and 76 (19.7%) patients had exacerbations during the 1‐year follow‐up. The mean RDQ score was 10.1 ± 4.7, and 132 (34.2%) patients were identified as having high GERD risk. Multivariate logistic regression analyses revealed that the high GERD risk (odds ratio, 2.31; 95% confidence interval, 1.29–3.87) was an independent risk factor of COPD exacerbations. In conclusion, high GERD risk appears to be associated with higher odds for COPD exacerbations.     

High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD

BACKGROUND: Gastroesophageal reflux disease (GERD) is common in a variety of chronic respiratory diseases, but little is known about GERD in the setting of COPD. The aims of this study were to determine the prevalence, presentation, and predictors of GERD based on proximal and distal esophageal pH monitoring in patients with severe COPD. METHODS: Forty-one COPD patients with a mean FEV1 of 24% of predicted underwent dual-probe 24-h esophageal pH monitoring, and 1 patient underwent esophagogastroduodenoscopy. RESULTS: The prevalence of GERD was 57%. Elevated distal and proximal reflux were present in 41% and 46% of patients undergoing esophageal pH studies, respectively. Fifteen percent of these patients had abnormal proximal reflux despite having normal distal probe results. Most patients with GERD were not receiving acid blockers at the time of their referral, and only one third reported heartburn and/or acid regurgitation during the pH study. Only higher body mass index was predictive of reflux on regression analysis (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.5; p = 0.05). CONCLUSIONS: GERD is common in advanced COPD. Patients are often asymptomatic and have a relatively high prevalence of isolated abnormal proximal reflux. Dual-probe monitoring is therefore well suited for detecting GERD in patients with advanced COPD.     

Association of Gastroesophageal Reflux Disease Symptoms with Stable Chronic Obstructive Pulmonary Disease

Background  

Patients with various chronic respiratory diseases have a higher incidence of gastroesophageal reflux disease (GERD)-related symptoms, but the mechanisms of the relationship between GERD symptoms and chronic obstructive pulmonary disease (COPD) remain unclear. The aim of the present study was to explore the association of GERD symptoms with impaired pulmonary function and other factors in patients with COPD.     

Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease

Background and Aim: It is speculated that the prevalence of gastroesophageal reflux disease (GERD) might increase with asthma or chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the prevalence of GERD in patients with asthma and COPD in an area representative of developing countries. Methods: A validated GERD questionnaire was conducted face‐to‐face with 308 consecutive asthma (240 women) and 133 COPD (35 women) patients in the tertiary referral pulmonary outpatient clinic, and 694 controls from the research area. Detailed histories of patients and pulmonary function tests were also recorded. Results: The prevalence of GERD (heartburn/regurgitation once a week or more) was 25.4%, 17.0%, 19.4% and occasional symptoms (less than weekly) were 21.2%, 16.3% and 27.0% of patients with asthma, COPD and controls, respectively. The prevalence was higher in the asthma group compared with the controls and the COPD group. No significant difference was found between the COPD group and the controls. Heartburn started following pulmonary disease in 24.1% of the asthma group, and 26.4% of the COPD group. The majority of additional symptoms were significantly higher in asthmatics compared with the controls. No difference was found in the consumption of pulmonary medications in asthmatic patients in groups with different symptom frequency. Heartburn was increased 13.8% by the consumption of inhaler medications. Conclusions: These results implicate that the prevalence of GERD in asthma and COPD are lower than in published reports in a tertiary referral center. These differences might be related to the characteristics of developing countries, increased consumption of powerful medications in GERD and pulmonary diseases, or methodological flaws in earlier studies.     

慢性阻塞性肺疾病患者的疾病进展及心理健康水平影响因素分析

目的:探讨慢性阻塞性肺疾病(COPD)患者的疾病进展及心理健康水平影响因素。方法:选取2019年1月至2019年9月,来我院呼吸与危重症医学科门诊就诊的COPD患者279例作为研究组,同时选取在我院进行体检的健康人群279例作为对照组。比较两组人群抑郁评分(SDS)、焦虑评分(SAS)、分析导致COPD患者发生抑郁、焦虑的相关因素、多因素分析导致COPD患者发生抑郁、焦虑的危险因素。结果:研究组SDS、SAS评分高于对照组(P<0.05);进一步分析,研究组患者有抑郁、焦虑情绪的患者共有93例,且年龄、性别、CAT评分、吸烟情况、疾病不同时期、急性加重频率、肠脑总分是导致COPD患者发生抑郁、焦虑的危险因素(P<0.05);年龄、性别、疾病不同时期、肠脑总分是导致COPD患者发生抑郁、焦虑的独立危险因素(P<0.05)。结论:COPD患者在临床治疗中应该根据患者的年龄、性别、疾病情况对其进行针对行的心理干预,让患者可以积极的接受治疗,同时还要关注患者的肠道健康状况,改善饮食习惯等,以便提高治疗效果,改善预后。     

Gastroesophageal reflux symptoms and nasal symptoms affect the severity of bronchitis symptoms in patients with chronic obstructive pulmonary disease

Background

Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD). Extrapulmonary comorbidities, such as gastroesophageal reflux disease (GERD) and post-nasal drip, also cause bronchitis symptoms. The impact of extrapulmonary comorbidities on the severity of bronchitis symptoms in COPD is unknown. The aim of this study was to quantify bronchitis symptoms and assess the impact of GERD and nasal symptoms on the severity of bronchitis symptoms in COPD.

Increased gastro-oesophageal reflux disease in patients with severe COPD.

The prevalence and clinical consequences of gastro-oesophageal reflux disease (GERD) in chronic obstructive pulmonary disease (COPD) are not well characterised. The present study prospectively studied 42 males with COPD (forced expiratory volume in one second % predicted: 35%, range 20-49) and 16 healthy volunteers of similar age without respiratory or gastro-oesophageal symptoms. The diagnosis of GERD was confirmed using oesophageal 24 h pH monitoring. In the current study group, reflux symptoms were measured using the Vigneri score, cough and dyspnoea with the modified Medical Research Council questionnaire, and pulmonary function with bronchodilator response and health status using St George's Respiratory Questionnaire. Pathological reflux was documented in 26 out of 42 patients (62%) and in three volunteers (19%). In patients with GERD, 15 patients (58%) did not report any reflux symptoms. There were no differences in symptoms, health status, bronchodilator treatment and pulmonary function test between patients with and without GERD. Oxygen desaturation coincided with episodes of increased oesophageal acidity in 40% of patients with GERD. Patients with severe chronic obstructive pulmonary disease have a high prevalence of asymptomatic gastro-oesophageal reflux. The association between this reflux and oxygen desaturation deserves further attention.     

High prevalence of gastroesophageal reflux in children after lung transplantation

Bronchiolitis obliterans and its clinical correlate bronchiolitis obliterans syndrome (BOS) are a major cause of morbidity and mortality following lung transplantation. Gastroesophageal reflux disease (GERD) may be a contributing factor for the development of BOS. Since 2002, all recipients of lung and heart-lung transplantation at our institution have been routinely investigated for GERD. In this observational study, we report on the prevalence of GERD in this population, including all pediatric patients undergoing single (SLTx) or double (DLTx) lung transplantation or heart-lung (HLTx) transplantation from January 2003-May 2004. GERD was assessed 3-6 months after transplantation by 24-hr pH testing. The fraction time (Ft) with a pH < 4 within a 24-hr period was recorded. Spirometry data, episodes of confirmed acute rejection, and demographic data were also collected. Ten transplant operations were performed: 4 DLTx, 1 SLTx, and 5 HLTx. Nine patients had cystic fibrosis. One patient had end-stage pulmonary disease secondary to chronic aspiration pneumonia and postadenovirus lung damage. Of 10 patients tested, 2 had severe GERD (Ft > 20%), 5 had moderate GERD (Ft 10-20%), 2 had mild GERD (Ft 5-10%), and 1 had no GERD. The only patient in this group with no GERD had a Nissen fundoplication pretransplant. All study patients were asymptomatic for GERD. All patients with episodes of rejection had moderate to severe GERD posttransplant. There was no association between severity of GERD and peak spirometry results posttransplant. Moderate to severe GERD is common following lung transplantation in children.     

Role of gastroesophageal reflux symptoms in exacerbations of COPD

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.