哮喘联盟

   摘要
   嗳气是胃食管返流性疾病的常见症状。如果经抗返流治疗症状未缓解，应该考虑其他病因。在此，我们报道了一例嗳气、返酸、胸闷和呼吸困难18个月且不断加重的43岁男性患者病例。胃镜检查提示浅表性胃炎。24小时食管pH值监测评分为11.4，处于正常范围。高分辨率食管测压结果显示完整松弛压力和食团内部压力高于正常范围（分别为20 mmHg 和 22.4 mmHg），提示胃食管交界处流出道梗阻。肺功能检测表明存在严重的阻塞性通气功能障碍（第1秒用力呼气量FEV1/最大肺活量为32%，FEV1为1.21L，吸入沙丁胺醇后只达到35%的预计值 ），支气管舒张试验阳性（∆FEV1 260 mL, ∆FEV1% 27%）。皮肤点刺试验粉尘螨（++），屋尘螨（++++），虾蛋白（++）。呼出气一氧化氮检测为76ppb。糖皮质激素和长效β2受体激动剂联合处理后，所有症状均得到缓解，且肺功能得到改善。最终由实验室检测和哮喘治疗效果确诊为支气管哮喘，因此内科医生，特别是消化科医生，应该多关注哮喘的嗳气症状。

 

（杨冬 审校）
World J Gastroenterol. 2015 Feb 7;21(5):1680-3. doi: 10.3748/wjg.v21.i5.1680.


 

Belching, regurgitation, chest tightness and dyspnea: Not gastroesophageal reflux disease but asthma.
 

Zhang JX1, Zhan XB1, Bai C1, Li Q1.

ABSTRACT
Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (∆FEV1 260 mL, ∆FEV1% 27%). DemeesterSkin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting β2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma.

World J Gastroenterol. 2015 Feb 7;21(5):1680-3. doi: 10.3748/wjg.v21.i5.1680.