Relationship between cugh sensitibity in upper respiratory tract and gastro-esophageal reflux

对14例咽部异物感患者和5例喉部肉芽肿患者进行了咳嗽敏感性测定，并对患者进行了胃食管反流和喉部检查。从最低浓度开始依次吸入辣椒碱溶液。引起咳嗽的辣椒素浓度平均为6.8μmol/L，低于对照组的11.2 μmol/L。这可能提示有球感的患者咳嗽敏感性增高，但与正常对照组无统计学差异。质子泵抑制剂（PPI）治疗2周后，14例患者中8例球形感消失，5例患者中2例慢性咳嗽减轻。PPI治疗后辣椒素浓度从6.8 μmol/l升高至8.5μmol/l 关于我们 补偿在8例改善了球感的患者中，5例患者在PPI治疗后显示咳嗽敏感性降低。6例患者中有2例未显示任何症状变化，咳嗽敏感性略有下降。所有5例喉肉芽肿患者在PPI治疗3个月后肉芽肿的大小都有很大改善。24 h pH监测显示，pH 4下的反流时间为2 min，pH 5下的反流时间为38 min，灵敏度从3.9下降到7.8。PPI治疗减轻了咽部异物感的结果表明，胃食管反流参与了咽部异物感的产生和咳嗽敏感性的升高。免疫组化结果显示，在大鼠喉粘膜中，辣椒素受体（香草素受体）抗体仅对少数纤维染色。这可能表明辣椒素引起咳嗽的伤害性感觉纤维是通过其他神经肽如CGRP或P物质或其他类型的香草素受体传递的。少

The cough sensitivity was measured in patients with globus sensation of the pharynx (14patients) and with laryngeal granuloma (5patients) after taking a history regarding gastro-esophageal reflux and laryngeal inspection : Capsaicin, cough inducing substance, was prepared in the concentration of 0 0.98,1.95,3.9,7.8,15.6,31.2,62.5,125,250 μ mol/l. The patients were inhalated with capsaicin solution in turn from the lowest concentration. Capsaicin concentration producing cough in globus sensation patients was 6.8μmol/l in average and it was lower than that in the control group of 11.2 μmol/l. This might indicate that the cough sensitivity was increased in patients with globus sensation but there was no statistical difference with normal control. After two week administration of proton pump inhibitor (PPI), their globus sensation was disappeared in 8 out of 14 patients, and chronic cough decreased in 2 out of 5 patients. Capsaicin concentration elevated from 6.8 to 8.5μmol/l after PPI tre … More atment. Out of 8 patients who improved their globus sensation, 5 patients revealed the decrease in cough sensitivity after PPI treatment. Two out of 6 patients who did not show any symptomatic change slightly decreased their cough sensitivity. All 5 patients with laryngeal granuloma showed a great improvement in the size of granuloma after 3 month PPI treatment. Twenty-four_hours pH monitoring revealed, that the reflux period under pH 4 was 2 minutes and the period under pH 5 was 38 minutes and sensitivity decreased from 3.9 to 7.8. The results that PPI treatment diminished the globus sensation suggest that the gastro-esophageal reflux participates in the generation of globus sensation of the pharynx and elevation of cough sensitivity. Immunohistochemical study in rats revealed that only a few fibers were stained by antibody against capsaicin receptor (vanilloid receptor) in the laryngeal mucosa. This may indicates that the nociceptive sensory fibers relating cough production by capsaicin is transmitted by other neuropeptides like, CGRP or substance P, or other type of vanilloid receptors. Less