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

对14例咽球感觉患者和5例喉肉芽肿患者进行胃食道反流和喉镜检查后测定咳嗽敏感度：辣椒素浓度为00.98，1.95，3.9，7.8，15.6，31.2，62.5,125,250μ/L，从最低浓度依次吸入辣椒素溶液。引起咳嗽的辣椒素平均浓度为6.8μ/L，低于对照组的11.2μ/L，提示感觉球患者咳嗽敏感度增加，但与正常对照组无统计学差异。应用质子泵抑制剂(PPI)治疗2周后，14例患者中8例眼球感觉消失，5例慢性咳嗽减轻。辣椒素浓度在PPItre…后由6.8mmol.L升至8.5mmol.更多的待遇。在8例球部感觉改善的患者中，5例患者在PPI治疗后咳嗽敏感度下降。没有任何症状变化的6名患者中，有2名患者的咳嗽敏感度略有下降。5例喉肉芽肿患者经PPI治疗3个月后，肉芽肿大小均有明显改善。24小时pH监测显示，pH 4下的回流时间为2分钟，pH 5下的回流时间为38分钟，灵敏度由3.9降至7.8。提示胃食道反流参与咽部球感的产生和咳嗽敏感度的提高。免疫组织化学研究表明，仅有少数纤维被辣椒素受体(香草素受体)抗体染色。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。较少

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