慢性咳嗽与胃食管反流的关系

目的:探讨慢性咳嗽与胃食管反流(GER)的相关性,以及胃食道反流所致咳嗽的临床特征、诊断和治疗。方法:对43例胸部X线、组胺激发试验、鼻部检查正常的慢性咳嗽患者进行24 h食管pH监测,并利用症状相关性概率(SAP)来分析咳嗽与反流的相关性。当至少符合以下之一时,诊断为GER:①24 h食道pH监测远端电极Demeester总积分≥12.70;②远端电极Demeester总积分虽小于12.70,但食道上、下电极至少有1个SAP大于75%。GER诊断确立后进行为期12周的抗反流治疗。结果:43例患者中,有26例符合GER并诊断为GER所致咳嗽,对这些患者进行抗反流治疗。疗程结束后,12例咳嗽完全消失,另14例咳嗽对抗反流治疗反应较差或无效。结论:GER与慢性咳嗽密切相关,是原因不明慢性咳嗽的一个重要原因。24 h食管pH监测结合症状相关性分析是诊断胃食管反流性咳嗽的主要手段,对胃食管反流性咳嗽患者应当进行抗反流治疗。

Association Between Chronic Cough and Gastroesophageal Reflux

Objective: To explore the association between chronic cough and gastroesophageal reflux(GER),and to investigate the clinical features,diagnosis and treatment of gastroesophageal reflux induced cough(GERC).Methods: Continuous ambulatory esophageal pH measurement was performed for 24 hour in 43 cases with chronic cough who had normal chest X-ray presentation,negative histamine provocation test and no abnormality of nasal cavity.The symptom association probability(SAP) was adopted to analyze the correlation of cough with gastroesophageal reflux.The unusual GER was defined subsequently if one of the following index was found: ① Total scores of far electrode Demeester≥12.70 in 24 hours surveillance of esophageal pH value.② Total scores of far electrode Demeester <12.70,but SAP ≥75% at least in one electrode.Once the diagnosis of unusual GER was established,anti-reflux medications were utilized to the patients for consecutive 12 weeks.Results: 26 out of 43 cases had GER and were diagnosed as GERC.The GERC patients were treated with anti-refluxdrugs.After treatment,cough in 12 patients were disappeared completely and the other 14 cases had no response.Conclusion: It can be concluded that the GER is closely associated with cough and may be an important inducing factor of chronic cough.Continuous esophageal pH measurement for the frequency and severity of gastroesophageal reflux and the SAP of cough were main diagnostic procedures for GERC.The patients with GERC should be treated with anti-reflux.