Acoustic Cough-Reflux Associations in Chronic Cough: Potential Triggers and Mechanisms
Acoustic Cough-Reflux Associations in Chronic Cough: Potential Triggers and Mechanisms
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DOI：
10.1053/j.gastro.2010.06.050
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发表时间：
2010-09-01
期刊：
影响因子：
29.4
通讯作者：
Houghton, Lesley A.
中科院分区：
文献类型：
--
作者：
Smith, Jaclyn A.;Decalmer, Samantha;Houghton, Lesley A.
背景与目的：中枢致敏被认为在慢性咳嗽中起作用，并可能解释在排除非戈尔反流（戈尔）原因的患者中咳嗽和胃食管反流（GOR）之间的时间相关性。使用我们新的同时声学咳嗽记录和阻抗/pH监测技术，我们旨在通过评估这种时间关联及其与返流酸度、持续时间和近端程度的关系以及糜烂性疾病和咳嗽反射敏感性的存在来进一步探索这一点。（即，包括非GOR原因）与慢性咳嗽。对71例慢性咳嗽患者进行了24小时动态声学咳嗽监测，同时记录阻抗/pH值，年龄51-64岁（47名女性）。此外，所有患者均接受了柠檬酸咳嗽反射敏感性试验，66例患者接受了胃镜检查。咳嗽和反流之间的时间关联表示使用的症状关联probability.RESULTS：70%的患者表现出时间关联，48%的患者有一个积极的症状关联概率（SAP（R-C））咳嗽前反流（主要是远端），56%的积极的症状关联概率（SAP（C-R（2分钟）咳嗽前反流，和32%。此外，与SAP（R-C）阴性患者相比，SAP（R-C）阳性患者咳嗽反射更敏感（P = 0.03），但食管反流暴露和糜烂性疾病相似，食管外咳嗽原因的患病率相似。咳嗽后立即出现反流的情况很少见。结论：无论提出的诊断如何，咳嗽在时间上与反流相关，在某些患者中可能会自我持续，并且可能是由中枢突起驱动的。
BACKGROUND & AIMS: Central sensitization is thought to play a role in chronic cough and might explain the temporal association between cough and gastroesophageal reflux (GOR) in patients in whom non-GOR causes have been excluded. Using our novel simultaneous acoustic cough recording and impedance/pH monitoring technique, we aimed to explore this further by assessing such temporal associations and their relationship to the acidity, duration, and proximal extent of reflux and the presence of erosive disease and cough reflex sensitivity in unselected patients (ie, including non-GOR causes) with chronic cough.METHODS: Twenty-four hour ambulatory acoustic cough monitoring with simultaneous impedance/pH recording was carried out in 71 unselected patients with chronic cough, aged 51-64 years (47 female). In addition, all patients underwent cough reflex sensitivity testing to citric acid, and 66 patients underwent gastroscopy. Temporal associations between cough and reflux were expressed using the symptom association probability.RESULTS: Seventy percent of patients exhibited temporal associations, with 48% having a positive symptom association probability (SAP(R-C)) for cough preceded by reflux (mainly distal), 56% a positive symptom association probability (SAP(C-R (2 min))) for reflux preceded by cough, and 32% both. Moreover, SAP(R-C) positive patients had a more sensitive cough reflex (P = .03) but similar esophageal reflux exposure and erosive disease, together with similar prevalence of extraesophageal causes of cough compared with SAP(R-C) negative patients. Reflux immediately following cough was rare.CONCLUSIONS: Cough temporally associates with reflux irrespective of proposed diagnoses, may be self-perpetuating in some patients, and is likely to be driven by central processes.