儿童胃食管反流患者的呼吸道症状
2017/10/09
摘要
儿童中的胃食管反流疾病是一类复杂的疾病，其所带来的呼吸系统临床病症（包括哮喘、慢性咳嗽以及喉炎）在儿科临床实践中很常见，但目前在该领域仍然存在较多疑问需要解答。对于存在食道外症状的疑似胃食管反流患者，目前的诊断手段（如PH或PH阻抗检测，喉镜，内镜）的准确性欠佳，因此上述这些情况之间的因果关系仍无定论。在个别存在（未经诊断的）呼吸道症状且疑似胃食管反流的患儿中，经验性地应用质子泵抑制剂或许对患儿有益，但其疗效并不可预测，且用药后所观察到的“疗效”可以为疾病病程本身的自行缓解所致。此外，这类药物的安全性遭到质疑。抗返流的药物治疗疗效较差提示有必要寻找导致患儿症状的非胃食管反流的病因。目前关于对疑似存在食管外症状的胃食管反流患儿症状评估的证据不足，因此进行有长期随访的纵向研究十分必要。
Respiratory manifestations of gastro-oesophageal reflux in children.
de Benedictis FM, Bush A.
Abstract
Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients' symptoms. Evidence for the assessment of children with suspected extra-oesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.
儿童中的胃食管反流疾病是一类复杂的疾病，其所带来的呼吸系统临床病症（包括哮喘、慢性咳嗽以及喉炎）在儿科临床实践中很常见，但目前在该领域仍然存在较多疑问需要解答。对于存在食道外症状的疑似胃食管反流患者，目前的诊断手段（如PH或PH阻抗检测，喉镜，内镜）的准确性欠佳，因此上述这些情况之间的因果关系仍无定论。在个别存在（未经诊断的）呼吸道症状且疑似胃食管反流的患儿中，经验性地应用质子泵抑制剂或许对患儿有益，但其疗效并不可预测，且用药后所观察到的“疗效”可以为疾病病程本身的自行缓解所致。此外，这类药物的安全性遭到质疑。抗返流的药物治疗疗效较差提示有必要寻找导致患儿症状的非胃食管反流的病因。目前关于对疑似存在食管外症状的胃食管反流患儿症状评估的证据不足，因此进行有长期随访的纵向研究十分必要。
（中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨 冬 审校）
（Arch Dis Child. 2017 Sep 7. doi: 10.1136/archdischild-2017-312890. [Epub ahead of print]）
（Arch Dis Child. 2017 Sep 7. doi: 10.1136/archdischild-2017-312890. [Epub ahead of print]）
Respiratory manifestations of gastro-oesophageal reflux in children.
de Benedictis FM, Bush A.
Abstract
Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients' symptoms. Evidence for the assessment of children with suspected extra-oesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.
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