CHRONIC COUGH DUE TO GASTROESOPHAGEAL REFLUX - CLINICAL, DIAGNOSTIC, AND PATHOGENETIC ASPECTS
CHRONIC COUGH DUE TO GASTROESOPHAGEAL REFLUX - CLINICAL, DIAGNOSTIC, AND PATHOGENETIC ASPECTS
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DOI：
10.1378/chest.104.5.1511
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发表时间：
1993-11-01
期刊：
影响因子：
9.6
通讯作者：
BENNETT, FM
中科院分区：
文献类型：
--
作者：
IRWIN, RS;FRENCH, CL;BENNETT, FM
背景：胃食管反流（GER）是慢性咳嗽的常见原因。此外，慢性咳嗽可能是GERD的唯一表现。最近有研究表明，GER最常通过刺激食管远端引起慢性咳嗽。为了获得进一步的诊断和病理生理学知识，我们前瞻性地评估了一组可能由GER引起的慢性咳嗽患者，并进行了广泛的胃肠道和呼吸系统研究，然后观察了他们对抗反流治疗的反应。方法：通过胸片、钡食管造影、食管远端和近端探针24小时食管pH监测（EPM）、食管镜和支气管镜检查，对12例可能由GER引起的慢性咳嗽进行前瞻性分析。然后，在实施抗反流治疗之前，我们以随机、双盲、标准化的方式（即伯恩斯坦酸灌注试验），客观地统计了在食管远端输注0.1盐酸或0.9%生理盐水溶液期间的咳嗽次数。结果：经抗反流治疗后咳嗽消失，确定胃食管反流是导致所有受试者咳嗽的原因。75%的患者临床表现为“沉默”。EPM是最常见的异常检查（敏感性为92%）。食管远端数据显示，12名受试者中有10人有胃热炎引起的咳嗽（12 +/- 12），而12名受试者中只有7人有食管pH常规参数（如百分比时间pH）异常
Background: Gastroesophageal reflux (GER) is a common cause of chronic cough. Moreover, chronic cough can be the sole presenting manifestation of GER disease (GERD). It has been suggested recently that GER most often causes chronic cough by stimulating the distal esophagus. To gain further diagnostic and pathophysiologic knowledge, we prospectively evaluated a group of patients with chronic cough likely to be due to GER with extensive gastrointestinal and respiratory studies and then observed their response to antireflux therapy.Methods: We prospectively characterized 12 subjects whose chronic cough was likely to be due to GER by chest radiographs, barium esophagography, 24-h esophageal pH monitoring (EPM) with probes in the distal and proximal esophagus, esophagoscopy, and bronchoscopy. Then, prior to instituting antireflux therapy, we objectively counted coughs during the distal esophageal infusion of 0.1 N HCl or 0.9 percent saline solution administered in a randomized, double-blind, standardized fashion (ie, Bernstein acid-perfusion test).Results: Gastroesophageal reflux was determined to cause cough in all subjects based on disappearance of cough with antireflux therapy. It was clinically ''silent'' in 75 percent. The EPM was the test most frequently abnormal (sensitivity, 92 percent). Distal esophageal data revealed that 10 of 12 subjects had GER-induced coughs (12 +/- 12) while only 7 of 12 had an abnormal esophageal pH conventional parameter (eg, percent time pH