胃食管反流与支气管哮喘

胃食管反流是指胃内容物通过食管下端括约肌频繁逆流到食管内从而引起的一系列临床症候群 ,而支气管哮喘是由多种原因引起的一种炎症性疾病 ,两种疾病早已为人们所熟知 ,但两者的关系多年来并未引起人们的足够重视。直到近年 ,随着有效的抑酸药物和便携式ｐＨ测试仪的出现 ,对这方面的研究才取得重大进展 ,并逐渐认识到胃食管反流可能是哮喘的一个激发因素[1 3 ] ,我们对目前哮喘和胃食管反流之间联系的机制、诊断与治疗作一综述。一、胃食管反流导致哮喘的机制1.迷走神经介导的反射 :气管支气管树与食管有相同的胚胎起源 ,远端的食管是由胚…     

支气管哮喘合并胃食管反流

支气管哮喘(简称哮喘)患者合并胃食管反流性疾病(GERD)的发生率高于一般人群,GERD和哮喘关系密切,互为因果,是哮喘控制不良和难治性哮喘的重要原因.GERD的诊断应纳入哮喘诊断常规程序.合理的抗反流治疗有助于改善哮喘控制.     

研究胃食管反流对哮喘患者肺通气功能的影响

目的探讨胃食管反流对哮喘患者肺通气功能的影响。 方法选取2016年8月至2017年8月,新疆维吾尔自治区人民医院接诊的102例哮喘患者纳入到随机对照试验中。根据有无发生胃食管反流将102例患者分为观察组(45例)和对照组(57例)。其中利用回顾性分析法对2组患者临床资料进行分析。 结果观察组45例患者肺功能各项指标明显差于对照组,差异有统计学意义(P<0.05)。 结论胃食管反流发生后会加重哮喘患者病情,严重影响肺通气功能,哮喘患者本身也容易诱发胃食管反流,提示临床治疗哮喘患者应给予相应的抗反流治疗。     

抗胃食管反流治疗对成年起病的支气管哮喘的疗效观察

胃食管反流与肺部疾病 ,尤其是支气管哮喘的关系越来越引起人们的重视。本文目的在于观察抗胃食管反流治疗对成年后起病的支气管哮喘的治疗效果。资料与方法研究对象　 1993～ 1995年我院收治 30岁以后首次患支气管哮喘住院者 5 4例 ,男 36例 ,女 18例 ,平均 4 3.2± 12 .5岁 ,作为对照组。 1996～ 1998年同样收治 30岁以后首次患支气管哮喘住院者 6 1例 ,男 4 2例 ,女 19例 ,平均 4 2 .6± 11.5岁 ,作为观察组。两组患者均符合中华结核和呼吸杂志及中华医学会呼吸学会组织的第一届全国哮喘会议上修订的支气管哮喘的定义、诊断、严重度分级…     

成年人胃食管反流与哮喘

胃食管反流作为成年人哮喘，尤其是内源性哮喘的激发因素，已逐渐引起人们的注意。本文阐述了成年人胃食管反流与哮喘之间关系的研究现状，胃食管反流引起哮喘发作的机理、临床表现、诊断、治疗和预防措施．     

抗胃食管反流治疗对缓解支气管哮喘急性发作的临床疗效观察

目的明确抗胃食管酸反流治疗对哮喘症状的协同治疗作用。方法将54例支气管哮喘患者依有无胃食管酸反流症状分为有GER表现组和无GER表现组，对比两组治疗疗效的差异性。结果两组治疗有效率分别为100％和69．23％，经统计学方法处理差异有显著性（P〈0．05）。结论支气管哮喘可合并有胃食管酸反流，经抗胃食管酸反流治疗可提高支气管哮喘的治疗效果。     

抗反流药物:治疗胃食管反流病的新方法

<正> 一、抗反流药物的概念未来几年内,通过阻断一过性下食管括约肌松弛(transient lower esophageal sphincter relaxations,TLESR)以达减少反流目的的抗反流药物可望成为胃食管反流病的治疗新选择。尽管反流病的病理生理学十分复杂,但大量异常反流物反流无疑是其关键性驱动力。抗反流手术的成功率很高,但抗反流药物治疗反流病的想法亦可行,这是由于"反流病     

胃食管反流与支气管哮喘之间的关系及抑酸药物对其的作用

目的探讨胃食管反流与支气管哮喘之间的关系及制酸药物对胃食管反流（GER）的作用分析。 方法随机选取新疆维吾尔自治区人民医院2016年9月至2017年9月接诊的122例哮喘患者的临床资料。根据有无发生胃食管反流将本组患者分为观察组（49例）和对照组（73例）。观察组49例患者为胃食管反流合并支气管哮喘,将观察组49例患者进行随机细分,25例患者利用制酸药物（质子泵抑制剂兰索拉唑）进行治疗,24例患者选择安慰剂进行治疗。对照组73例哮喘患者未合并胃食管反流。对2组患者临床资料进行分析。对比2组患者肺功能指标等相关资料,以此探讨胃食管反流与支气管哮喘的相互关系。评价制酸药物对胃食管反流的影响。 结果观察组45例患者肺功能各项指标明显差于对照组73例患者,差异有统计学意义（P<0.05）。制酸治疗组与安慰剂治疗组比较,差异有统计学意义（P<0.05）。 结论支气管哮喘患者容易因各种因素发生胃食管反流,胃食管反流也容易诱发支气管哮喘,并且在发生胃食管反流后会加重哮喘患者病情会,是难治性哮喘的重要诱因。临床治疗胃食管反流患者应利用抑酸药物进行相应的抗反流治疗,效果显著,可显著改善肺功能。     

支气管哮喘合并胃食管返流21例临床分析

本文报道支气管哮喘合并胃食管返流21例,对其发生返流的原因、诊断线索和治疗问题进行了讨论.     

胃食管反流病对哮喘患者肺功能影响的研究

目的探讨胃食管反流病对哮喘患者肺功能的影响。 方法收集2015年5月至2017年8月新疆维吾尔自治区人民医院收治并确诊哮喘226例患者的临床资料,根据是否合并有胃食管反流病(GERD)患者分为GERD组102例和非GERD组124例,比较2组患者FEV1占预计值%、FVC占预计值%及FEV1 /FVC%等肺功能指标。 结果GERD发生率45.1%(102/226),GERD组患者FEV1占预计值%、FVC占预计值%及FEV1/FVC%,明显低于非GERD组,差异有统计学意义(P<0.05)。 结论哮喘与GERD密切相关,GERD对哮喘患者肺功能影响大,GERD与哮喘是因果还是伴随关系仍需进一步研究。     

Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

AIM: To study the effect of combined omeprazole (Ome) and domperidone (Dom) therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph- ageal reflux. METHODS: We selected 198 asthmatics with gastroesophageal reflux diagnosed by 24-h esophageal pH monitoring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk (1:1 double-blind randomization). Spirometry was done at baseline and af- ter 16 wk of treatment. The primary outcome measures were: mean daily daytime and nighttime asthma symp- tom scores. Mean daily reflux symptom scores, albuterol use as rescue medication (number of puffs), daytime and nighttime peak expiratory flow rate (PEFR), postbroncho- dilator forced expiratory volume in 1 second (FEV1) and postbronchodilator forced vital capacity (FVC) were secondary outcome measures. RESULTS: Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score (17.4% vs 8.9%), nighttime asthma symptom score (19.6% vs 5.4%), reflux symptom score (8.7% vs 1.6%) and rescue medication use (23.2% vs 3.1%) after antire- flux therapy compared to mean change in placebo group (P < 0.001). There was significant improvement in morn- ing PEFR (7.9% vs 0.2%), evening PEFR (9.8% vs 0.5%), FEV1 (11.1% vs 3.78%) and FVC (9.3% vs 1.52%) in the antireflux therapy group compared to placebo on compar-ing the mean change from baseline after 16 wk (P < 0.01).     

小儿食管裂孔疝反流和手术抗反流机制的研究

目的了解小儿食管裂孔疝（ＨＨ）发生反流和手术抗反流的作用机制。方法２０例经钡餐造影确诊的ＨＨ患儿进行手术前后食管２４小时ｐＨ监测和食管动力功能检查。结果２０例患儿均有病理性胃酸反流；术后各项反流指标除了平均反流周期外均显著改善，下食管括约肌长度（ＬＥＳＬ）显著增加（从１．１７ｃｍ增加到１．９４ｃｍ．Ｐ＜０．０１）．主要是腹内食管段增加明显（从０．５４ｃｍ增加到１．３０ｃｍ，Ｐ＜０．０５）。胃内压降低（从２．８６ｍｍＨｇ降到１．７８ｍｍＨｇ，Ｐ＜０．０１）：术后腹内食管段长度影响治疗效果，长度长则疗效好（Ｐ＜０，０５）；手术前后下食管括约肌压力（ＬＥＳＰ）无显著差别（Ｐ＞０．０５）。结论小儿ＨＨ发生反流的机制是由于ＬＥＳ长度不足，主要是腹内食管段长度不足甚至消失及胃内压增高引起；手术抗反流的机制定增加了ＬＥＳ的长度，主要是增加了腹内食管段的长度。     

Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis

OBJECTIVE:

To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations.

METHODS:

We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction.

RESULTS:

Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001).

CONCLUSIONS:

GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.     

胆汁反流检测在胃食管反流病诊断中的意义

目的研究食管胆汁反流的发生情况,探讨其与酸、碱反流的关系及其对胃食管反流病（ＧＥＲＤ）的诊断意义。方法应用便携式２４小时ｐＨ监测仪及胆汁监测仪同步检测反流性食管炎（ＲＥ）、胃切除术后者及健康志愿者共３４例的食管内２４小时ｐＨ变化及胆汁反流情况。结果ＲＥ组食管酸暴露时间比对照组及胃手术后组均显著增加。各组间ｐＨ＞８总时间百分比结果相似,均较低。食管胆汁反流用胆红素吸收值≥０．１４的时间百分比表示,以胃手术后组为最高,ＲＥ其次,二组均较对照组明显为高。食管胆汁反流与酸暴露时间之间密切相关（ｒ＝０．７５,Ｐ＜０．０５）。６３．６％的ＲＥ患者同时存在酸及胆汁反流。结论食管胆汁反流并不少见,可与酸反流同时存在,其在ＧＥＲＤ的发生过程中起一定作用。同步动态检测食管内ｐＨ值及胆汁对ＧＥＲＤ的诊断有重要意义。     

十二指肠胃食管反流在胃食管反流病中的作用

目的　研究十二指肠胃食管反流 (DGER)在胃食管反流病发病机制中的作用及其对非糜烂性反流病 (NERD)的诊断价值。方法　 95例患者根据内镜检查的结果分为反流性食管炎和NERD组 ,对其均进行 2 4h食管 pH和胆汁联合监测。 结果　反流性食管炎患者DGER的各项指标 :吸光度值 >0 14时间百分比 (% )、总反流次数和反流 >5min的次数分别为 19 0 5± 2 3 4 4、30 5 6±34 0 4和 5 90± 6 37,均显著高于NERD组相应的 7 2 6± 11 0 8、15 6 8± 2 0 92和 2 5 9± 3 5 7(P <0 0 5 ) ,而酸反流差异无显著性 ,随着反流性食管炎的程度加重DGER发生率增高 ;18 2 %的NERD患者存在单纯DGER ,联合胆汁监测可使NERD诊断阳性率由 6 5 9%升高到 84 1%。结论　DGER可以单独发生 ,在引起反流性食管黏膜损伤或症状方面都有作用 ,2 4h食管 pH和胆汁联合监测有助于NERD的诊断。     

Belching,regurgitation,chest tightness and dyspnea:Not gastroesophageal reflux disease but asthma

Belching is a common symptom of gastroesophageal reflux disease.If the symptoms are not relieved after anti-reflux treatment,another etiology should be considered.Here,we report a case of a 43-yearold man who presented with belching,regurgitation,chest tightness and dyspnea for 18 mo,which became gradually more severe.Gastroscopic examination suggested superficial gastritis.Twenty-four-houresophageal pH monitoring showed that the Demeester score was 11.4,in the normal range.High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal(20 mm Hg and 22.4 mm Hg,respectively),indicating gastroesophageal junction outflow tract obstruction.Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second(FEV1)/forced vital capacity 32%,FEV1 was 1.21 L,occupying 35% predicted value after salbuterol inhalation],and positive bronchial dilation test(△FEV1 260 m L,△FEV1% 27%).Skin prick test showed Dermatophagoides farinae(++),house dust mite(++++),and shrimp protein(++).Fractional exhaled nitric oxide measurement was 76 ppb.All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting β2-agonist.Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment,therefore,physicians,especially the Gastrointestinal physicians,should pay attention to the belching symptoms of asthma.     

阻塞性睡眠呼吸暂停与胃食管反流的关系及对抗反流治疗的效果

目的 研究阻塞性睡眠呼吸暂停（ＯＳＡ）与胃食管反流（ＧＥＲ）的关系及西沙必利和奥美拉唑对两者的治疗效果。方法 １８例有睡眠打鼾和反流症状的患者接受了昼夜食管ｐＨ和压力监测,并在夜间睡眠时与多导睡眠图（ＰＳＧ）同步监测;对同时有ＧＥＲ和ＯＳＡ患者予以西沙必利（１０ｍｇ,４次／日）和奥美拉唑（２０ｍｇ,２次／日）治疗１周后重复以上检查。结果 ７例（３８．９％）同时合并有ＯＳＡ及重度ＧＥＲ,除１例外不仅     

Association between diabetes mellitus and gastroesophageal reflux disease:A meta-analysis

AIM:To investigate whether there is a link between diabetes mellitus(DM) and gastroesophageal reflux disease(GERD).METHODS:We conducted a systematic search of Pub Med and Web of Science databases,from their respective inceptions until December 31,2013,for articles evaluating the relationship between DM andGERD.Studies were selected for analysis based on certain inclusion and exclusion criteria.Data were extracted from each study on the basis of predefined items.A meta-analysis was performed to compare the odds ratio(OR)in DM between individuals with and without GERD using a fixed effect or random effect model,depending on the absence or presence of significant heterogeneity.Subgroup analyses were used to identify sources of heterogeneity.Publication bias was assessed by Begg’s test.To evaluate the results,we also performed a sensitivity analysis.RESULTS:When the electronic database and hand searches were combined,a total of nine eligible articles involving 9067 cases and 81 968 controls were included in our meta-analysis.Based on the randomeffects model,these studies identified a significant association between DM and the risk of GERD(overall OR=1.61;95%CI:1.36-1.91;P=0.003).Subgroup analyses indicated that this result persisted in studies on populations from Eastern countries(OR=1.71;9 5%C I:1.3 8-2.1 2;P=0.0 0 3)a n d i n y o u n g e r patients(mean age50 years)(OR=1.70;95%CI:1.22-2.37;P=0.001).No significant publication bias was observed in this meta-analysis using Begg’s test(P=0.175).The sensitivity analysis also confirmed the stability of our results.CONCLUSION:This meta-analysis suggests that patients with DM are at greater risk of GERD than those who do not have DM.     

埃索美拉唑治疗老年胃食管反流相关性哮喘69例临床观察

目的 观察埃索美拉唑抗反流治疗对胃食管反流相关性哮喘的疗效.方法 69例胃食管反流相关性哮喘患者,在常规哮喘治疗基础上均给予每日1次每次埃索美拉唑40 mg+每日3次每次莫沙必利5 mg抗反流控制治疗8周,之后每日1次每次埃索美拉唑20 mg+每日临睡前莫沙必利5 mg维持治疗.按中华医学会呼吸病学分会哮喘组制定的支气管哮喘防治指南哮喘控制水平分级标准来观察疗效.随访2年.结果 哮喘完全控制39例、部分控制25例,有效率92.8%.完全停用哮喘治疗药物42例、用量减半18例、继续用药9例.随访2年,哮喘完全控制58例、偶有发作11例,但发作次数减少、程度减轻.结论 埃索美拉唑抗反流治疗胃食管反流相关性哮喘可明显改善患者症状,提高生活质量.