Chronic Cough Due to Gastroesophageal Reflux in Adults CHEST Guideline and Expert Panel Report
Chronic Cough Due to Gastroesophageal Reflux in Adults CHEST Guideline and Expert Panel Report
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DOI：
10.1016/j.chest.2016.08.1458
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发表时间：
2016-12-01
期刊：
影响因子：
9.6
通讯作者：
Irwin, Richard S.
中科院分区：
文献类型：
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作者：
Kahrilas, Peter J.;Altman, Kenneth W.;Irwin, Richard S.
背景：我们更新了 2006 年 ACCP 反流咳嗽综合征治疗临床实践指南。方法：通过系统评价解决了两个群体、干预、比较、结果 (PICO) 问题：(1) 胃食管反流治疗能否改善或消除成人慢性持续性咳嗽的咳嗽？ (2)是否有最低临床标准来指导实践确定慢性咳嗽可能对胃食管反流治疗有反应？结果：我们没有发现与这两个问题相关的高质量研究。从解决问题 1 的现有随机对照试验 (RCT) 中，我们得出结论：(1) 安慰剂对改善咳嗽有很强的作用； (2) 包括饮食调整和减肥在内的研究具有更好的咳嗽效果； (3) 虽然改变生活方式和减轻体重可能对疑似反流咳嗽综合征有益，但质子泵抑制剂 (PPI) 单独使用时没有任何益处； (4) 由于潜在的残留效应，应避免使用 PPI 进行交叉研究。对于问题 2，我们从现有的观察性试验中得出结论：(1) 算法管理方法可以解决 82% 至 100% 的慢性咳嗽问题； (2) 鼻窦疾病引起的咳嗽变异性哮喘和上呼吸道咳嗽综合征 (UACS)（以前称为鼻后滴流综合征）是最常见的病因；结论：小组成员 (1) 赞同使用诊断/治疗算法来解决常见咳嗽的原因，包括症状性反流；(3) 报告的反流咳嗽综合征患病率差异很大。 (2) 建议虽然改变生活方式和减轻体重可能对疑似反流咳嗽综合征有益，但 PPI 单独使用时没有任何益处； (3) 建议对考虑进行抗反流手术的难治性患者或临床强烈怀疑需要诊断检测的患者进行生理检测。
BACKGROUND: We updated the 2006 ACCP clinical practice guidelines for management of reflux-cough syndrome.METHODS: Two population, intervention, comparison, outcome (PICO) questions were addressed by systematic review: (1) Can therapy for gastroesophageal reflux improve or eliminate cough in adults with chronic and persistently troublesome cough? and (2) Are there minimal clinical criteria to guide practice in determining that chronic cough is likely to respond to therapy for gastroesophageal reflux?RESULTS: We found no high-quality studies pertinent to either question. From available randomized controlled trials (RCTs) addressing question # 1, we concluded that (1) there was a strong placebo effect for cough improvement; (2) studies including diet modification and weight loss had better cough outcomes; (3) although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, proton pump inhibitors (PPIs) demonstrated no benefit when used in isolation; and (4) because of potential carryover effect, crossover studies using PPIs should be avoided. For question # 2, we concluded from the available observational trials that (1) an algorithmic approach to management resolved chronic cough in 82% to 100% of instances; (2) cough variant asthma and upper airway cough syndrome (UACS) (previously referred to as postnasal drip syndrome) from rhinosinus conditions were the most commonly reported causes; and (3) the reported prevalence of reflux-cough syndrome varied widely.CONCLUSIONS: The panelists (1) endorsed the use of a diagnostic/therapeutic algorithm addressing causes of common cough, including symptomatic reflux; (2) advised that although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome, PPIs demonstrated no benefit when used in isolation; and (3) suggested that physiological testing be reserved for refractory patients being considered for antireflux surgery or for those in whom there is strong clinical suspicion warranting diagnostic testing.