Chronic cough due to gastroesophageal reflux disease - ACCP evidence-based clinical practice guidelines
Chronic cough due to gastroesophageal reflux disease - ACCP evidence-based clinical practice guidelines
复制标题
DOI：
10.1378/chest.129.1_suppl.80s
复制
发表时间：
2006-01-01
期刊：
影响因子：
9.6
通讯作者：
Irwin, RS
中科院分区：
文献类型：
--
作者：
Irwin, RS
目的：对有关咳嗽和胃食管反流病（GERD）的文献进行批判性回顾和总结，并对GERD引起的慢性咳嗽的诊断和治疗提出循证建议。设计/方法：奥维德MEDLINE文献综述（至2004年3月）自1963年以来以英语发表的所有研究和以其他语言（如法语）发表的选定文章，使用医学主题标题术语“咳嗽”、“胃食管反流”和“胃食管反流病”。“结果：GERD，单独或与其他疾病结合，是慢性咳嗽最常见的原因之一。对于胸部放射学检查结果正常的患者，GERD最有可能通过刺激食道-支气管反射而引起咳嗽。当GERD引起咳嗽时，75%的时间可能没有GI症状。虽然24小时食管pH监测是将GERD和咳嗽联系在因果关系中最敏感和特异性的测试，但它有其局限性。此外，关于如何最好地解释测试没有普遍的一致意见，并且它不能检测非酸反流事件。因此，当患者符合临床特征，有很高的可能性预测GERD是咳嗽的原因，抗反流药物治疗应根据经验制定。虽然一些患者通过最低限度的药物治疗改善，但其他患者需要更密集的治疗方案。当经验性治疗失败时，不能假定GERD已被排除为慢性咳嗽的原因。相反，建议对GERD进行客观调查，因为经验性治疗可能不够密集，或者药物治疗可能失败。手术可能是有效的，当强化的药物治疗已经失败，在选定的患者谁经历了广泛的客观GERD evaluation.Conclusions：准确诊断和成功治疗慢性咳嗽由于GERD可能是一个重大挑战。
Objectives: To critically review and summarize the literature on cough and gastroesophageal reflux disease (GERD), and to make evidence-based recommendations regarding the diagnosis and treatment of chronic cough due to GERD.Design/methodology: Ovid MEDLINE literature review (through March 2004) for all studies published in the English language and selected articles published in other languages such as French since 1963 using the medical subject heading terms "cough," "gastroesophageal reflux," and "gastroesophageal reflux disease."Results: GERD, singly or in combination with other conditions, is one of the most common causes of chronic cough. In patients with normal chest radiographic findings, GERD most likely causes cough by stimulation of an esophageal-bronchial reflex. When GERD causes cough, there may be no GI symptoms up to 75% of the time. While 24-h esophageal pH monitoring is the most sensitive and specific test in linking GERD and cough in a cause-effect relationship, it has its limitations. In addition, there is no general agreement on how to best interpret the test, and it cannot detect non-acid reflux events. Therefore, when patients fit the clinical profile that has a high likelihood of predicting that GERD is the cause of cough, antireflux medical therapy should be empirically instituted. While some patients improve with minimal medical therapy, others require more intensive regimens. When empiric treatment fails, it cannot be assumed that GERD has been ruled out as a cause of chronic cough. Rather, an objective investigation for GERD is then recommended because the empiric therapy may not have been intensive enough or medical therapy may have failed. Surgery may be efficacious when intensive medical therapy has failed in selected patients who have undergone an extensive objective GERD evaluation.Conclusions: Accurately diagnosing and successfully treating chronic cough due to GERD can be a major challenge.