Gastro-oesophageal reflux and aspiration of gastric contents in adult patients with cystic fibrosis
Gastro-oesophageal reflux and aspiration of gastric contents in adult patients with cystic fibrosis
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DOI：
10.1136/gut.2007.146134
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发表时间：
2008-08-01
期刊：
影响因子：
24.5
通讯作者：
Sifrim, D.
中科院分区：
文献类型：
--
作者：
Blondeau, K.;Dupont, L. J.;Sifrim, D.
背景资料：胃食管反流（戈尔）在囊性纤维化（CF）中增加，但其患病率，特征，与胃吸入和呼吸影响的关系尚未得到很好的表征。我们调查了成人CF patients.Methods：33例CF患者[19例男性; 29（18-55）岁，[10例肺移植后（LTx）]进行了阻抗pH监测，用于检测酸（pH，4）和弱酸性戈尔（pH 4-7）。对16例患者进行食管测压，客观记录咳嗽，计算症状关联概率（SAP）。结果：28例患者的戈尔增加（21例为酸性，5例为弱酸性，2例为酸性+弱酸性），10例SAP为反流性咳嗽阳性。非LTx和LTx后CF患者的戈尔参数相似。反流性咳嗽顺序明显多于反流性咳嗽。38例患者中有16例在唾液中有胆汁酸，6/10例在BALF中有胆汁酸，这几乎只在基因型DF 508/DF 508的患者中观察到。仅12/28例戈尔比升高和9/22例唾液/BALF胆汁酸升高患者有典型反流症状。食管酸暴露与咳嗽呈正相关（r = 0.53，p = 0.03）。结论：戈尔增高在CF中普遍存在，但不继发于咳嗽。酸性戈尔是常见的，但也可能发生弱酸性戈尔。CF患者有很高的误吸风险，反流似乎与更多的咳嗽和较差的肺功能有关。需要进行强抗反流治疗的结局研究，以证实反流在CF进展中的有害作用。
Background: Gastro-oesophageal reflux (GOR) is increased in cystic fibrosis (CF), but its prevalence, characteristics, association with gastric aspiration and respiratory impact are not well characterised. We investigated acid and weakly acidic reflux, aspiration and respiratory symptoms/function in adult CF patients.Methods: Thirty-three CF patients [19 men; 29 (18-55) years, [10 post-lung transplant (LTx)] underwent impedance-pH monitoring for detection of acid (pH, 4) and weakly acid GOR (pH 4-7). In 16 patients cough was objectively recorded with oesophageal manometry, and the symptom association probability (SAP) was calculated. Saliva and bronchoalveolar lavage fluid (BALF) were tested for bile acids.Results: Twenty-eight patients had increased GOR (21 acid, 5 weakly acidic and 2 acid+weakly acidic) and 10 had a positive SAP for reflux cough. GOR parameters were similar in non-LTx and post-LTx CF patients. The sequence reflux cough was significantly more common than cough reflux. Sixteen of 38 patients had bile acids in saliva and 6/10 in BALF and this was almost exclusively observed in patients with genotype DF508/DF508. Only 12/28 with increased GOR and 9/22 with bile acids in saliva/BALF had typical reflux symptoms. There was a positive correlation (r = 0.53, p = 0.03) between oesophageal acid exposure and cough. SAP-positive patients with for reflux cough had a lower lung function than SAP-negative patients.Conclusion: Increased GOR is prevalent in CF and not secondary to cough. Acid GOR is common, but weakly acidic GOR may also occur. CF patients have a high risk of aspiration and reflux seems to be associated with more cough and poorer lung function. Outcome studies with intense anti-reflux therapy are needed to confirm the deleterious role of reflux in CF progression.