慢性咳嗽及哮喘与胃食管反流

胃食管反流病（Ｇａｓｔｒｏｅｓｏｐｈａｇｅａｌｒｅｆｌｕｘｄｉｓｅａｓｅ，ＧＥＲＤ）是由于胃、十二指肠内容物反流入食管引起反酸、烧心、反食等症状或组织损害，部分患者有食管以外的表现，发生在有呼吸道症状者是无呼吸道症状者的２倍〔１〕，因此认识ＧＥＲ与呼...     

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。     

西沙必利治疗胃食管反流性支气管哮喘的临床观察

支气管哮喘（哮喘）并胃食管反流（GER）发生率远较正常人高。亦有研究认为胃食管反流有诱发和加剧哮喘的作用。1992年12月～1997年12月我院应用西沙必利治疗GER性哮喘28例,现报告如下。临床资料一、一般资料53例患者,年龄21～63岁,平均34±12岁。病程1～10年,平均3．3±2．5年。随机分为两组,治疗组28例,对照组25例。两组病人的平均病程、年龄、性别及哮喘分型构成比均无统计学差异（P＞0.05）。二、诊断标准全部病例均符合中华医学会呼吸病学会1993年修订的支气管哮喘诊断标准,并具备以下的GER诊断条件：①具有胃食管反流疾病…     

十二指肠胃食管反流在胃食管反流病中的作用

本文研究了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。研究中将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 4 h食管p H和胆汁联合监测。结果显示: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>5 min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…     

胃食管反流相关性哮喘25例临床分析

1995年4月～1998年4月我院收治胃食管反流(GER)相关性哮喘25例,现报告如下. 临床资料 一、一般资料 25例患者中,男15例,女10例.年龄20～65岁,平均52.5岁.病程5个月～16年,平均6.5年.均符合1997年全国哮喘会议修正的支气管哮喘诊断标准并具有GER的典型症状:胸骨后及剑突下疼痛、胸骨后烧灼感、嗳气、反酸和吞咽痛等.GER先于哮喘者12例,哮喘发作期内GER症状加重,哮喘先于GER者10例,3例不详.应用支气管扩张剂及激素治疗5个月～16年,平均32个月.     

奥美拉唑治疗儿童胃食管反流并发哮喘19例

目的探讨质子泵抑制药改善儿童胃食管反流并发的哮喘症状的作用。方法 38例胃食管反流并发哮喘儿童患者,随机分成两组,每组19例。两组均给予短效哮喘药物控制症状,再分别用奥美拉唑20mg&#183;d-1和安慰药治疗。结果奥美拉唑对食道酸抑制作用明显（反流指数〈5.0）。奥美拉唑和安慰药对症状指数均有改善,但差异无显著性[奥美拉唑1.28（95%CI为-0.1～2.65）,安慰药1.28（95%CI为-0.72～3.27）];对生活质量均有改善[奥美拉唑为0.62（95%CI为0.29～0.95）,安慰药0.50（95%CI为0.29～0.70）],两组间差异无显著性。两组的肺功能和短效支气管扩张药物使用差异无显著性。结论奥美拉唑对儿童胃食管反流伴发的哮喘症状无明显的改善作用。     

胃食管反流病的药物治疗策略

胃食管反流病发病率和复发率高,影响患者的生活质量,尤其是对于质子泵抑制剂(PPI)难治性胃食管反流病患者。其治疗包括4个方面:改变生活方法、药物治疗、内镜和手术治疗。本文综述国内外对该病的药物治疗策略。     

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。     

支气管哮喘合并胃食管反流病及食管裂孔疝1例

患者，男，78岁。因阵发性腹痛、腹泻、呕吐3d，伴发热2d于2003年12月17日入院。患者入院前3d无诱因出现上腹部阵发性绞痛，并腹泻5次，呈稀水样便，呕吐一次为胃内容物，饮食欠佳。2d前出现发热，最高达39．3℃。门诊查大便常规示：潜血( )，白细胞( )，红细胞( )，遂以“急性胃肠炎”收入院。患者既往有支气管哮喘病史15年，高血压、冠心病12年，     

胃食管反流病的药物治疗

在简要介绍胃食管反流病发病机理的基础上,对其药物治疗的临床实施和疗效评价进行阐述,为胃食管反流病的临床治疗提供参考。     

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。     

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.     

抗反流治疗对胃-食管反流相关性哮喘患者的临床观察

目的观察抗反流治疗对胃-食管反流(GER)相关性哮喘的影响。方法82例GER相关性哮喘患者,在常规哮喘治疗基础上均给予抗返流治疗8周。结果抗返流治疗后,48例临床控制(58%),34例好转(42%);68例需要长期服用支气管扩张剂的患者,44例完全停用(64.3%),24例用量减少一半以上(35.7%);62例需要长期服用糖皮质激素的患者,42例停药(68%),20例减量(32%)。结论抗反流治疗GER相关性哮喘,能明显改善患者的症状。     

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:

反流性疾病问卷对胃食管反流病的诊断价值

目的探讨反流性疾病问卷（RDQ）在诊断胃食管反流病中的价值。方法在接待消化内科门诊就诊病人中,对存在反流相关症状者进行问卷调查。记录烧心、反流、非心源性胸痛、反酸4个症状的频率及程度的积分,分析经内镜检查证实的反流性食管炎患者RDQ积分分布情况,计算诊断GERD的临界值。结果1655例门诊病人中379人有反流症状,男女比例1.11：1,平均年龄50.16±14.17岁。经内镜检查,诊断反流性食管炎122例,内镜正常者73例,二者RDQ评分差异有显著。以RDQ分值16为临界值,Youden指数最大,ROC曲线下面积为0.75,对GERD诊断阳性符合率81.48%,阴性符合率为60.92%,敏感度为72.13%,特异度为68.49%。RDQ分值与RE的洛杉矶分级无关。结论RDQ可作为初步诊断胃食管反流病易行有效的方法。     

Evolving drugs in gastroesophageal reflux disease: pharmacologic treatment beyond proton pump inhibitors

Importance of the field: Despite the clinical success of proton pump inhibitors to treat gastroesophageal reflux disease (GERD), for the majority of patients in both gastroenterology and primary care clinics there is still a substantial group of patients (up to 40% in some studies) who do not completely respond symptomatically to a standard dose of proton pump inhibitors (PPIs). Specific explanations for these PPI noncomplete responders included transient lower esophageal sphincter relaxations (TLESRs), sensitivity to weakly acidic and/or alkaline reflux, large volume of reflux and esophageal hypersensitivity. There is a clear need for GERD therapies beyond the PPIs.

Areas covered in this review: These drug classes include the GABA_B receptor agonists (including lesogaberan and arbaclofen placarbil), mGluR5 receptor antagonists, P-CABs, cholecystokinin₂ antagonists and add-on therapies to PPIs including mosapride and rikkunshito.

What the reader will gain: Both physicians and patients are eagerly awaiting the development and FDA approval of a new class of anti-GERD medications targeting distinct mechanisms. This article provides information on pharmacologic strategies, clinical trials and side-effect profiles on several of the most promising and heavily researched compounds being developed today for the treatment of GERD symptoms and inflammation. Hopefully, this important research will help a large group of PPI noncomplete responding patients receive symptomatic relief and reduce esophageal inflammation through a unique pharmacologic mechanism in the near future.

Take home message: The treatment of GERD has greatly improved with the PPI class of therapy. Despite excellent success, there is a sizeable population of patients who do not have adequate response to therapies directed only at acid suppression. Emerging new pharmacologic treatment options show promise in further advancing the treatment success of GERD.     

Emerging drugs for gastroesophageal reflux disease

Proton pump inhibitors (PPIs) are very effective and safe drugs for the treatment of erosive and non-erosive gastroesophageal reflux disease (GERD). Nevertheless, a significant proportion of GERD patients (30 – 40%) continue to suffer from symptoms during PPI treatment, which has stimulated the search for better drugs. Improvement of PPI pharmacokinetics and pharmacodynamics has been the main focus of drug development in the past decade with the ultimate goal of optimizing acid inhibition. New inhibitors of the proton pump with a longer half-life, acting faster and longer, have been developed, including potassium-competitive acid blockers. Recent data, however, suggest that the therapeutic efficacy of acid suppression may have reached its maximum and other mechanisms may have to be targeted to further improve symptom control. Potential drugs interacting with different targets are reflux inhibitors such as GABA_B receptor agonists and mGluR5 antagonists. These agents reduce the number of transient lower esophageal sphincter relaxation thereby reducing both acid and non-acid reflux. Theoretically, visceral analgesics to modulate visceral perception or even growth factors to enhance mucosal healing may be other emerging drugs to treat GERD.     

兰索拉唑联合莫沙必利治疗非糜烂性胃食管反流病的疗效观察

目的 观察兰索拉唑治疗非糜烂性胃食管反流病(NERD)的疗效.方法 将64例NERD患者完全随机分为观察组和对照组.观察组32例,予兰索拉唑30 mg,早餐前1次;莫沙比利5 mg,早、中、晚餐前各1次;对照组32例,予兰索拉唑30 mg,早餐前1次.治疗前及治疗8周时进行胃食管反流病量表(GerdQ)评分,并于治疗8周后进行疗效评定.结果 观察组显效20例,有效7例,总有效率为84.4％ (27/32);对照组显效15例,有效5例,总有效率为62.5％ (20/32);2组总有效率比较差异具有统计学意义(P＜0.05).治疗8周后2组GerdQ评分均较治疗前下降[观察组:(7.0±2.0)分比(9.8±2.6)分;对照组:(8.2±2.0)分比(10.3±2.1)分;均P＜0.05],且治疗8周后观察组GerdQ评分低于对照组(P＜0.05).结论 兰索拉唑联合莫沙比利治疗NERD疗效优于单用同剂量兰索拉唑.