支气管哮喘与胃食管反流相关性研究

目的：分析支气管哮喘伴胃食管反流患者与支气管哮喘无胃食管反流患者的胃镜下食管粘膜病理差异，哮喘的轻重，肺功能及喘、咳周平均日次数。方法：将54例就诊的支气管哮喘病人随机分为两组；支气管哮喘无胃食管反流症状组(1组)30例，支气管哮喘伴胃食管反流症状组(2组)24例，所有病人均经食管胃镜检查同时测定FEV1、PEF和喘、咳周平均日次数，两组进行比较和统计学分析。结果：2组均有食管粘膜的病理变化，1组部分病人也存在着潜在食管粘膜的病理变化，两组差异非常显著；两组病情严重程度差异有显著性，2组的病情明显重于1组；两组FEV1、PEF值差异有显著性，2组的FEV1、PEF值明显小于1组；2组的喘、咳用平均日次数明显犬于1组，差异有显著性。结论：胃食管反流对支气管哮喘患者的肺功能有一定的影响；伴胃食管反流支气管哮喘病情较重；无反流症状的支气管哮喘也可能存在着潜在的反流。     

兰索拉唑治疗胃食管反流病临床观察

胃内容物反流至食管并不一定都导致疾病发生,当胃内容物反流至食管引起了症状或和组织损伤,称为胃食管反流性疾病（GERD）。反流引起的食管损伤（反流性食管炎）在内镜下表现为食管鳞状上皮形成糜烂或溃疡。反流性食管炎可进一步并发食管狭窄和技状上皮增生（Barrett食管）。GERD可以有多种多样的临床表现,在某些病人,反流的胃内容物抵达咽部而引起咽痛、舌灼痛或牙齿侵蚀。吸入反流物可导致喉炎和肺部疾患,如咳嗽、支气管炎和哮喘。有研究显示GERD病人的生活质量较正常对照组明显下降。传统治疗方式是改变生活方式,药物治疗选…     

反流性食管炎治疗药物选择

反流性食管炎治疗药物选择０５００００河北医科大学第二医院药剂科赵树藩反流性食管炎是由于胃内容物反流进食管引起的酸紊乱性疾病〔１〕。发生反流的原因包括食管下部括约肌张力下降，腹压升高和食管廓清能力下降。临床症状有烧心、上腹疼痛、咳嗽、哮喘、声嘶等。反流...     

自杀性、抑郁筛查以及抗抑郁药物：对FDA警告的反应

胃食管反流在哮喘患者中很普遍，但一般只有轻度症状有时甚至没有任何症犬。目前还不清楚使用质子泵抑制剂治疗控制不良哮喘患者中的胃食管反流是否可以从根本上改善对哮喘的控制。因此研究人员组织了—项平行分组双盲试验，共收纳了412例有轻微或者无胃食管反流症状的控制不良哮喘患者。     

胃源性哮喘患儿的抗反流治疗28例报告

胃食管反流(GER)是引起或加剧支气管哮喘,尤其是内源性哮喘的一个重要因紊[1]。我们对28例胃源性哮喘患儿给予抗反流治疗并进行临床随访观察,现报告如下。     

西米替丁、西沙必利治疗伴胃食管反流的支气管哮喘的临床研究

诱发哮喘的原因非常多 ,而胃食管反流 ( GER)是儿科常见的上消化道动力紊乱 ,近年来研究表明 GER是引起和加重哮喘的一个重要因素。本文对 14例哮喘伴胃食管反流的患儿运用抗反流治疗 ,并进行对照研究 ,以观察抗反流治疗对伴GER的哮喘的治疗作用 ,并进一步证实 GER与哮喘的内在     

胃食管反流病42例误诊分析

胃食管反流病是指由于胃内容物反流至食管而引起的不适症状或并发症,是常见的消化系统疾病之一。胃食管反流病的主要症状是烧心和反流,但很多时候表现为其他非典型的症状,如反复咳嗽、胸痛、胸闷、哮喘、咽喉不适等。     

联合抗反流药物治疗胃-食管反流相关性哮喘32例临床分析

胃-食管反流相关性哮喘是哮喘治疗效果不佳的原因之一,经抗反流药物治疗一般可使症状得到减轻或控制。我院自2008年1月至2009年9月共收治老年胃-食管反流相关性哮喘32例,在哮喘治疗的同时联合抗反流药物治疗取得满意效果,我们对其病例资料进行了回顾性分析,现报道如下：1临床资料1.1一般资料32例均同时符合支气管哮喘及胃-食管反流病的诊断标准。其中男21例,女11例;年龄42～78岁,平均63岁,〉65岁21例（65.6%）;病程1～19年,     

食管外表现为主要症状的胃食管反流病32例

目的提高对胃食管反流病的诊治水平。方法对2003-2013年我们收治的以食管外表现为主要症状的32例胃食管反流病患者临床资料进行分析总结。结果本组均无典型胃食管胃反流症状,主要表现慢性咳嗽14,哮喘5例,非心源性胸痛11例,咽部不适2例,确诊前病程2~39个月,经确诊胃食管反流病给予相应治疗后,症状均有明显好转。结论对于久治不愈的慢性咳嗽、哮喘、心绞痛样胸痛、咽部不适等症状的患者,应考虑胃食管反流病的可能,提高对该病的诊治水平。     

胃食管反流误诊为冠状动脉粥样硬化性心脏病10例

胃食管反流性疾病（GERD）临床常见，是由于胃、十二指肠内容物等有害物质，反流入食管引起的一组临床症状和食管组织损害。主要表现为嗳气、泛酸和胸骨后疼痛三大症状。胃食管反流（GER）与部分哮喘、咳嗽、夜间呼吸暂停有关外，尚与心绞痛样胸骨疼痛有关。在临床工作中，往往只重视对食管的损害而忽视可能引起的胸骨疼痛症状，容易误诊。本文将我院收治的10例报告如下。     

反流性食管炎与气道高反应性研究

目的：探讨反流性食管炎对气道反应性的影响。方法：选择经支气管激发试验确诊为支气管哮喘且伴有烧心、反酸等消化道症状的患者32例，再行电子胃镜检查，比较反流性食管炎严重程度与肺功能各参数的关系。对确诊为反流性食管炎患者中的12例服用洛赛克20mg，每日2攻，2周后再行肺功能检查测定气道反应性，对比治疗前后肺功能各参数的改变。结果：32例哮喘且伴有消化道症状的患者中经胃镜检查反流性食管炎发生率为84％（27／32）．其中12例患者服用洛赛克治疗2周后气道反应性减低，FEV1与FEV1／FVC无明显改变。结论：胃食管反流可诱发并加重哮喘，通过治疗胃食管反流可以控制哮喘。     

Influence of theophylline on gastro-oesophageal reflux and asthma

Summary The aim of the study was to determine whether gastro-oesophageal (GO)-reflux was increased by normal maintenance doses of theophylline, and if so, whether this was detrimental to lung function in asthmatic patients with symptoms of reflux. In 25 patients with moderate or severe bronchial asthma and a history of respiratory symptoms aggravated by reflux, two consecutive oesophageal 24-h pH recordings were made, one with and the other without their ordinary dose of slow release theophylline.The theophylline treatment caused a significant increase in total reflux time and reflux symptoms but did not worsen the asthma. Patients with subtherapeutic serum levels showed significant improvement in lung function and those with therapeutic serum levels did not.It is concluded that theophylline, in view of its potential to exacerbate GO-reflux, should be used with caution as maintenance therapy in asthmatic patients with GO-reflux.     

Role of gastroesophageal reflux disease in asthmatic patients

The association between gastroesophageal reflux disease (GERD) and asthma is well accepted. The prevalence of GERD increases in asthmatics compared with normal controls, whereas GERD may induce or exacerbate asthma. They interact with each other in a cause and effect relationship. But the mechanism by which GERD might induce or aggravate asthmatic symptoms remains unclear. Two mechanisms have been proposed, including (1) acid in the inflamed esophagus acting on exposed receptor causes an increase in bronchial hyper-responsiveness via the vagal reflex; (2) microaspiration of gastric contents damage the bronchial mucosa, which result in inflammation of the mucosa and bronchial hyper-responsiveness. Among the GERD diagnostic methods, ambulatory esophageal pH monitoring bears the highest sensitivity. Ambulatory esophageal pH monitoring is recommended in patients without classic reflux symptoms or those with difficult to control asthma. Both medical and surgical antireflux therapy could improve asthma symptoms, asthma medication requirements, and even pulmonary function in a proportion of asthmatics.     

The role of proton-pump inhibitor therapy in patients with gastroesophageal reflux disease and difficult-to-control asthma

Difficult-to-control asthma is a frustratingly difficult condition to treat. Many factors contribute to this condition, including gastroesophageal reflux disease. Response to potent acid suppressive therapy with proton-pump inhibitors is less than universal or complete, and underlines the multifactorial nature of the disease. However, the authors of this paper feel strongly that, whereas gastroesophageal reflux disease can be reliably identified, patients with difficult-to-control asthma will experience an improvement in symptoms when treated with acid-suppressive therapy, while bearing in mind that other contributory factors may have to be eliminated at the same time.     

The role of proton-pump inhibitor therapy in patients with gastroesophageal reflux disease and difficult-to-control asthma

Difficult-to-control asthma is a frustratingly difficult condition to treat. Many factors contribute to this condition, including gastroesophageal reflux disease. Response to potent acid suppressive therapy with proton-pump inhibitors is less than universal or complete, and underlines the multifactorial nature of the disease. However, the authors of this paper feel strongly that, whereas gastroesophageal reflux disease can be reliably identified, patients with difficult-to-control asthma will experience an improvement in symptoms when treated with acid-suppressive therapy, while bearing in mind that other contributory factors may have to be eliminated at the same time.     

Review article: respiratory manifestations of gastro-oesophageal reflux disease

Background  Respiratory manifestations represent one of the most prevalent and difficult-to-manage extra-oesophageal syndromes of gastro-oesophageal reflux disease.
Aims  To review the epidemiology, pathophysiological mechanisms and therapeutic outcomes of reflux-related respiratory disorders.
Methods  Search of the literature published in English using PubMed database.
Results  There is a discrepancy between the high prevalence of reflux in asthmatics and the limited efficacy of antireflux therapies. Asthma per se may cause reflux. Patients with difficult-to-treat asthma and/or nocturnal symptoms should be screened for reflux. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and proton pump inhibitors in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Attention has been drawn to obstructive sleep apnoea syndrome.
Conclusions  The role of gastro-oesophageal reflux disease in the pathogenesis of miscellaneous respiratory disorders has been discussed for decades and established in asthma and cough. However, no major therapeutic advances have been reported recently. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring.     

Gastroesophageal reflux disease in children with asthma: treatment implications

An association between asthma and gastroesophageal reflux disease (GERD) has long been recognized both mechanistically and epidemiologically. The clinical relevance of this interplay continues to be explored, with special interest given to the role of GERD in the worsening of asthma. The effect of GERD is most frequently contemplated in patients with asthma that is difficult to control. Medical and surgical anti-reflux trials attempting to alter asthma symptoms have reported mixed but generally underwhelming results, although asthma symptom scores are generally improved following effective treatment of GERD. Many of the pharmaceutical studies can be criticised for having too short a duration or for likely incomplete acid suppression. Few trials have specifically studied pediatric populations. Because GERD is a common condition, particularly in young children, the role reflux plays in the worsening of asthma symptoms and the potential benefit on asthma of anti-reflux therapy warrants further exploration. Whether or not treating symptomatic GERD reduces the symptoms and severity of asthma in children, GERD coexisting with asthma should be aggressively treated. GERD symptoms in most patients with or without asthma can be controlled medically with continuous use of proton pump inhibitors such as omeprazole and lansoprazole and to a lesser extent by histamine H(2) receptor antagonists such as famotidine and cimetidine.     

吗丁啉治疗胃食管反流相关性支气管哮喘疗效观察

目的：观察吗丁啉对胃、食管反流相关性支气管哮喘的疗效。方法：对50例胃、食管反流相关性支气管哮喘患，在支气管哮喘急性发作时给予常规对症治疗的同时，给予口服吗丁啉20mg,tid；伴有慢性胃炎加服雷米替丁0.3g、阿莫西林0.5g及灭滴灵0.2g,tid；有胃酸过多夜间加服洛赛克（losec)20mg。4wk为一个疗程，第一个疗程结束后，停药观察1－4wk，病情复发继服第二个疗程。结果：第一个疗程结束后，有45例病人停止发病，观察6mon病情未复发。5例在停药1－4wk病情复发，继服第二个疗程后。5例在停药1－4wk病情复发，继服第二个疗程后，有4例停止发病，随访6mon未复发，1例发病次数减少一半。结论：吗丁啉用以预防和治疗胃、食管反流相关性支气管哮喘具有良好效果。     

A belated revelation: from gastroesophageal reflux derived asthma to laryngotracheal irritation even spasm

The author has been inspired by the Global Evidence-Based Consensus for gastroesophageal reflux (GER), which put forward four extra-esophageal syndromes: reflux cough syndrome, reflux laryngitis syndrome, reflux dental erosion syndrome and the reflux asthma syndrome. The author himself happened to receive five emergency rescue treatments following apparent “bronchial asthma”, which was to be diagnosed as GER at his own insistence. PPI resulted in some relief. After being rescued again from suffocation, he had a fundaplication, which was performed at the Englewood Hospital & Medical Center, Englewood, USA in March 2006. The procedure immediately cleared up his “asthma”. A month later he brought forth a Center for GER in an army hospital in Beijing, China. Up to now, 601 patients with mainly respiratory distress (84%) were treated by Stretta Radiofrequency, 58 by surgery and more by PPI. The GER Center is now complete with a ward. GER patients with respiratory distresses turned out to fare better than those with acid regurgitation. A nozzle-shaped pharynx was found in patients with the reflux. Animal study revealed that the refluxate entered into trachea and even lungs. Gradually a hypothesis of a gastrooesophago-laryngo-tracheal reflux took shape. Our modest effort to treat GER-derived respiratory distresses has got off to an encouraging start amid relative shortage of experience and facilities. We would like to share two thoughts with scholars and experts at home and abroad: