哮喘联盟

   摘要
   胃食道反流病（GERD）是当胃内容物反流时产生的一种情况，具有烧心和反流的典型症状。胃肠道症状已被认知，然而尚有诸如哮喘、慢性咳嗽、咽喉炎和鼻窦炎等胃反流病食管外症状。伴随哮喘发病率升高，研究胃食管反流病如何影响哮喘的发展和治疗日益得到关注。由于内窥镜和pH监测敏感性较低，采用质子泵抑制剂(PPIs)的经验治疗是现在针对怀疑具有胃食管反流病相关症状患者的首要诊断步骤。如果治疗无效，治疗结束后的pH监测和/或治疗时的阻抗和pH监测可能是评估具有前述症状基线水平反流发生率的合理手段，并能通过接下来的试验排除持续性的或较弱的酸反流。PPI治疗无效的哮喘患者且无明显反流症状，通常无反流或者并非由胃食管反流病引起。在此类患者中应终止使用PPI治疗。对于胃食道反流病导致的患者，应持续使用抑酸治疗同时最好采用伴随治疗其他病因。胃底折叠术很少采用，但对于具有大的食道裂孔疝以及pH监测中到重度反流的患者，胃底折叠术可能有助于不再使用高剂量抑酸治疗。
 

（杨冬 审校）
Expert Rev Gastroenterol Hepatol. 2015 Jun 11:1-14. [Epub ahead of print]

 

Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay.
 

Naik RD1, Vaezi MF.
 

Abstract
Gastroesophageal reflux disease (GERD) is a condition that develops when there is reflux of stomach contents, which typically manifests as heartburn and regurgitation. These esophageal symptoms are well recognized; however, there are extra-esophageal manifestations of GERD, which include asthma, chronic cough, laryngitis and sinusitis. With the rising incidence of asthma, there is increasing interest in identifying how GERD impacts asthma development and therapy. Due to the poor sensitivity of endoscopy and pH monitoring, empiric therapy with proton pump inhibitors (PPIs) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. If unresponsive, diagnostic testing with pH monitoring off therapy and/or impedance/pH monitoring on therapy, may be reasonable in order to assess for baseline presence of reflux with the former and exclude continued acid or weakly acid reflux with the latter tests. PPI-unresponsive asthmatics, without overt regurgitation, usually have either no reflux or causes other than GERD. In this group, PPI therapy should be discontinued. In those with GERD as a contributing factor acid suppressive therapy should be continued as well as optimally treating other etiologies requiring concomitant treatment. Surgical fundoplication is rarely needed but in those with a large hiatal hernia, moderate-to-severe reflux by pH monitoring surgery might be helpful in eliminating the need for high-dose acid suppressive therapy.

Expert Rev Gastroenterol Hepatol. 2015 Jun 11:1-14. [Epub ahead of print]