Chronic Cough and Gastroesophageal Reflux in Children CHEST Guideline and Expert Panel Report
Chronic Cough and Gastroesophageal Reflux in Children CHEST Guideline and Expert Panel Report
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DOI：
10.1016/j.chest.2019.03.035
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发表时间：
2019-07-01
期刊：
影响因子：
9.6
通讯作者：
Weinberger, Miles
中科院分区：
文献类型：
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作者：
Chang, Anne B.;Oppenheimer, John J.;Weinberger, Miles
背景：胃食道反流(GER)或胃食道反流病(GERD)是否会引起儿童慢性咳嗽一直存在争议。使用人口、干预、比较、结果(PICO)格式，我们进行了四次系统评价。适合患有慢性咳嗽的儿童(>；持续4周)并且没有潜在的肺部疾病：(1)没有胃肠道GER症状的人，是否应该使用GERD的经验性治疗？(2)有胃肠道GER症状的GERD的治疗能解决咳嗽吗？(3)有或没有胃肠道GER症状的GERD应该使用什么基于GER的治疗，持续多长时间？(4)如果怀疑GERD是咳嗽的原因，什么调查和诊断标准最好确定GERD是咳嗽的原因？方法：我们使用胸科专家咳嗽小组的方案和美国胸科医师学会(胸科)的方法学指南和分级(建议，发展和评价)框架。结果：很少有随机对照试验解决前两个问题，也没有一个解决后两个问题。单一荟萃分析(两个随机对照试验)显示两组之间没有显著差异(治疗GERD的任何干预措施与缓解咳嗽的安慰剂相比，OR为1.14；95%CI为0.45-2.93；P=.78)。质子泵抑制剂(与安慰剂相比)导致严重不良事件增加。现有胸咳系统评价的定性数据符合两个国际GERD指南。结论：专家小组同意：(1)当GERD没有临床特征时，不应使用S治疗GERD；(2)应使用儿科GERD指南来指导治疗和研究。
BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough?METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus.RESULTS: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P = .78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines.CONCLUSIONS: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.